History

Obtain a complete history as part of the evaluation of the infant or child with possible sepsis. Fever is the most common presenting symptom of children with systemic inflammatory response syndrome (SIRS). A parental report of measured (not tactile) fever can generally be assumed to be reliable.

Ask the caregiver whether any of the following have been noted: a racing heart, rapid or labored breathing, cool extremities, or color changes. Identify exposures to infectious illnesses and other sources of insult.

Discuss the child’s activity level. Perform an age-appropriate evaluation of mental status. Ask about urine output because it is the most sensitive historical marker of dehydration and potential renal hypoperfusion. Verify immunizations, and confirm drug allergies.

Physical Examination

Perform a complete physical examination of the infant or child with suspected sepsis. Subtle changes in vital signs (eg, minimal tachycardia, widened pulse pressure, minimal tachypnea, minimally delayed capillary refill) may be the first signs of impending SIRS. Hypotension, mental status changes, and anuria are late signs. Hypothermia is often a more ominous sign than fever.

Elicit localizing signs of infection. A petechial or purpuric rash associated with fever is of particular concern. Frequent reassessment during interventions is required.

Because the manifestations of pediatric sepsis are protean, the possible complications are as well. Complications depend on the nature of the triggering insult and the resultant host response.

Differential Diagnoses

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