Medscape is available in 5 Language Editions – Choose your Edition here.


Pediatric Sepsis Workup

  • Author: Shankar Santhanam, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Sep 29, 2015

Laboratory Studies

Blood and urine studies

Obtain a complete blood count (CBC). In the era of pneumococcal occult bacteremia, the likelihood of a positive blood culture result for pneumococci increased as the white blood cell (WBC) count increased. However, an elevated WBC count is no longer predictive of bacteremia when widespread pneumococcal conjugate vaccination is practiced.

Elevated band and other immature counts, toxic granulation, toxic vacuolation, Dohle bodies, and, particularly, low WBC counts are findings of particular concern (although they are quite nonspecific). Hemoconcentration may be present and can be helpful as a gauge of hydration status.

Measures of clotting function and coagulation parameters may be helpful. Disseminated intravascular coagulopathy (DIC), hypercoagulability, and other clotting dysfunctions may be seen in infants and children with systemic inflammatory response syndrome (SIRS).

Electrolyte level tests, renal and liver function tests, and other chemistry tests may have a role. Serum transaminase levels and other measures of liver dysfunction are often elevated in situations such as disseminated viral and anaerobic infections.

Etiology-specific serologies may be helpful, and urinalysis may have a role in clarifying the level of risk of urinary tract infection in infants and children. In addition, non–culture-based molecular modalities and other diagnostic methods are becoming increasingly important.[12]

The use of inflammatory markers and acute-phase reactants (eg, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], interleukin [IL]–1b, IL-6, IL-8, tumor necrosis factor–alpha, leukotriene B4, procalcitonin [PCT]) in the diagnosis and management of pediatric sepsis is evolving.[13, 14]

A study aimed to determine biomarker phenotypes that differentiate children with sepsis who require intensive care from those who do not. The study concluded that in children ages 2-17 years, combining metabolomic and inflammatory protein mediator profiling early after presentation may differentiate children with sepsis requiring care in a pediatric intensive care unit from children with or without sepsis safely cared for outside a pediatric intensive care unit. The authors also add that these results may aid in making triage decisions, particularly in an ED without pediatric expertise.[15]

Culture of blood, urine, and CSF

Whenever possible, obtain a blood culture before starting antibiotics. The yield is clearly correlated to the volume of blood sampled. Culture of bone marrow may have a higher yield for certain pathogens (eg, Histoplasma capsulatum).

Obtain a urine culture unless, in an older child, a genitourinary source of infection can be reliably excluded.

Obtain a cerebrospinal fluid (CSF) culture before initiating antibiotic therapy if the child’s condition is stable but clinical evaluation cannot exclude central nervous system (CNS) infection. Many pathogens can be recovered from CSF cultures several hours after a dose of antibiotics; thus, a child whose condition is unstable should receive antibiotics and be stabilized before lumbar puncture. Once the child’s condition is stable, identification of CSF pleocytosis is helpful, even if prolonged antibiotic therapy may have rendered culture results negative.

Culture of skin lesions, eye drainage, throat, vagina, rectum, cellulitic areas, nasal secretions, sputum, tracheal aspirates, and stool may be helpful in the appropriate clinical context.

Viral cultures may have a role in certain contexts, although many viral infections are diagnosed via molecular methods or serologically.

Other Studies and Procedures

Obtain a chest radiograph; pneumonia, pleural effusions, adenopathy, and other conditions may be revealed. Pursue other imaging modalities (eg, computed tomography [CT] or magnetic resonance imaging [MRI]) as the clinical context dictates. Echocardiography may be indicated in certain clinical settings.

Lumbar puncture may be indicated for CSF evaluation. Sampling of other fluids or biopsy of various organs or tissues may be necessary.

Contributor Information and Disclosures

Shankar Santhanam, MD Consulting Staff, Department of Emergency Medicine, Emergency Medical Associates; Consulting Staff, Department of Family Medicine, Capital Health Systems

Shankar Santhanam, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.


Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases,

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Reuters. Presepsin an accurate biomarker for late-onset sepsis in preemies. Medscape Medical News. December 18, 2014. [Full Text].

  2. Poggi C, Bianconi T, Gozzini E, Generoso M, Dani C. Presepsin for the Detection of Late-Onset Sepsis in Preterm Newborns. Pediatrics. 2014 Dec 15. [Medline].

  3. Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan. 6(1):2-8. [Medline].

  4. Gaines NN, Patel B, Williams EA, Cruz AT. Etiologies of septic shock in a pediatric emergency department population. Pediatr Infect Dis J. 2012 Nov. 31(11):1203-5. [Medline].

  5. Soeorg H, Huik K, Parm U, Ilmoja ML, Metelskaja N, Metsvaht T. Genetic Relatedness of Coagulase-negative Staphylococci From Gastrointestinal Tract and Blood of Preterm Neonates With Late-onset Sepsis. Pediatr Infect Dis J. 2013 Apr. 32(4):389-93. [Medline].

  6. Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics. 2012 Mar. 129(3):e590-6. [Medline].

  7. Harding H. Catheter dwell time longer than two weeks tied to higher sepsis risk in infants. Medscape Medical News. November 12, 2013. Available at Accessed: November 19, 2013.

  8. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter Dwell Time and CLABSIs in Neonates With PICCs: A Multicenter Cohort Study. Pediatrics. 2013 Nov 11. [Medline].

  9. Stoll BJ, Hansen NI, Bell EF, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA. 2015 Sep 8. 314 (10):1039-51. [Medline].

  10. Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011 Jun 30. 364(26):2483-95. [Medline].

  11. Myburgh JA. Fluid resuscitation in acute illness--time to reappraise the basics. N Engl J Med. 2011 Jun 30. 364(26):2543-4. [Medline].

  12. Mancini N, Carletti S, Ghidoli N, Cichero P, Burioni R, Clementi M. The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev. 2010 Jan. 23(1):235-51. [Medline]. [Full Text].

  13. Rajani AK, Philip AGS. Diagnostic Tests in Neonatology: Evaluation and Interpretation Using Sepsis as an Example. NeoReviews. 2011 Jul. 12(7):e368-e373.

  14. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev. 2012 Oct. 25(4):609-34. [Medline].

  15. Mickiewicz B, Thompson GC, Blackwood J, Jenne CN, Winston BW, Vogel HJ, et al. Development of metabolic and inflammatory mediator biomarker phenotyping for early diagnosis and triage of pediatric sepsis. Crit Care. 2015 Sep 9. 19:320. [Medline].

  16. [Guideline] Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008 Jan. 34(1):17-60. [Medline]. [Full Text].

  17. [Guideline] Yager P, Noviski N. Shock. Pediatr Rev. 2010 Aug. 31(8):311-8; quiz 319. [Medline].

  18. Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011 Jun. 127(6):e1585-92. [Medline].

  19. Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of Risk of Early-Onset Sepsis in Newborns >=34 Weeks' Gestation. Pediatrics. 2013 Dec 23. [Medline].

  20. Henderson D. Risk-Based EOS Approach Could Curb Antibiotics for Newborns. Medscape [serial online]. Available at Accessed: December 30, 2013.

  21. Skinner SC, Iocono JA, Ballard HO, Turner MD, Ward AN, Davenport DL, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. J Pediatr Surg. 2012 Jan. 47(1):63-7. [Medline].

  22. Rodríguez-Núñez A, López-Herce J, Gil-Antón J, Hernández A, Rey C. Rescue treatment with terlipressin in children with refractory septic shock: a clinical study. Crit Care. 2006 Feb. 10(1):R20. [Medline]. [Full Text].

  23. Manzoni P, Rinaldi M, Cattani S, Pugni L, Romeo MG, Messner H, et al. Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial. JAMA. 2009 Oct 7. 302(13):1421-8. [Medline].

  24. Pammi M, Abrams SA. Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2011 Oct 5. CD007137. [Medline].

  25. Manzoni P, Stolfi I, Messner H, Cattani S, Laforgia N, Romeo MG, et al. Bovine lactoferrin prevents invasive fungal infections in very low birth weight infants: a randomized controlled trial. Pediatrics. 2012 Jan. 129(1):116-23. [Medline].

  26. Haque KN, Pammi M. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev. 2011 Oct 5. CD004205. [Medline].

  27. FDA Safety Alert. Xigris [drotrecogin alfa (activated)]: Market Withdrawal - Failure to Show Survival Benefit. US Food and Drug Administration. Available at Accessed: October 26, 2011.

  28. PR Newswire. Lilly Announces Withdrawal of Xigris® Following Recent Clinical Trial Results. Lilly. Available at Accessed: October 26, 2011.

  29. Barton P, Kalil AC, Nadel S, Goldstein B, Okhuysen-Cawley R, Brilli RJ, et al. Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. Pediatrics. 2004 Jan. 113(1 Pt 1):7-17. [Medline].

  30. Weiss KD. Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis. Pediatrics. 2004 Jan. 113(1 Pt 1):134. [Medline].

  31. Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis. Arch Dis Child. 2013 Feb. 98(2):146-54. [Medline].

  32. Harrison L. Gentamicin does not increase kidney risk in pediatric sepsis. Medscape Medical News. January 15, 2014. [Full Text].

  33. Mussap M. Laboratory medicine in neonatal sepsis and inflammation. J Matern Fetal Neonatal Med. 2012 Oct. 25 Suppl 4:32-4. [Medline].

Pathogenesis of sepsis and multiple organ dysfunction syndrome (MODS).
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.