ID - Paediatric Sepsis

Question 1

What is sepsis?

Answer 1

Life threatening organ dysfunction due to dysregulated host response to infection

Question 2

What is the response to pathogens in sepsis?

Answer 2

Pathogens recognised by macrophages, lymphocytes and mast cells

Large release of cytokines, interleukins and TNF to alert the immune system

Question 3

What causes vasodilation in sepsis?

Answer 3

Cytokine release causes immune activation which leads to nitrous oxide release

Nitrous oxide causes vasodilation

Question 4

Why do you get raised lactate in sepsis?

Answer 4

Cytokines increase endothelial permeability

This causes fluid to leak out from blood

Fluid accumulates and surrounds blood vessels decreasing oxygen delivery to tissues

Cells undergo anaerobic respiration and lactate builds up

Question 5

What causes disseminated intravascular coagulopathy in sepsis?

Answer 5

Coagulation system activation

Fibrin deposition throughout circulation, decreases organ and tissue perfusion further

Consumption of platelets and clotting factors as used up to form blood clots

Leads to thrombocytopenia, haemorrhages and inability to form clots

Question 6

What is septic shock?

Answer 6

Circulatory collapse and organ hypoperfusion

Arterial blood pressure falls causing organ hypo-perfusion

Leads to rise in blood lactate as anaerobic respiration starts

Question 7

When is septic shock diagnosed?

Answer 7

When sepsis causes cardiovascular dysfunction

Question 8

How is septic shock treated?

Answer 8

Aggressive IV fluids to improve blood pressure and tissue perfusion

If fluid boluses fail to improve blood pressure and lactate escalate to HDU or ITU

Inotropes e.g. NorAd can be given

Question 9

What are the signs of sepsis?

Answer 9

Prolonged CRT
Fever or hypothermia
Deranged behaviour
Poor feeding
Incosolable
High pitched or weak cry
Reduced consciousness
Floppy (reduced body tone)
Mottled skin
Cyanosed

Question 10

What is the most common feature of sepsis?

Answer 10

Fever or history of fever

Question 11

what is a non-blanching rash most suggestive of?

Answer 11

Neisseria meningitidis

Question 12

If an infant is under 3 months with a temperature over 38 what should be done?

Answer 12

Treat urgently for sepsis until proven otherwise

Question 13

Learn

Answer 13

Question 14

How is sepsis managed?

Answer 14

Give 3
High flow oxygen
IV fluids 20ml/kg if lactate over 2mmol/L
Iv antibiotics

Take 3
Blood cultures
Blood lactate
Monitor urine output, can use catheter

Question 15

When giving fluids what should be considered for children?

Answer 15

Particularly prone to hypoglycaemia

Correct with 2ml/kg bolus of 10% dextrose if blood sugar under 3mmol/L

Question 16

What further management should be used in suspected sepsis?

Answer 16

CXR - if pneumonia suspected
AXR and Pelvic USS - If intra-abdominal infection suspected
LP - meningitis
Meningococcal PCR
Serum cortisol - adrenal crisis

Question 17

How long should antibiotics be continued for if bacterial infection suspected or confirmed?

Answer 17

5-7 days

Question 18

When can you consider stopping antibiotics?

Answer 18

If patient is well
Blood cultures and two CRP results negative at 48 hours

Question 19

What are the most common causative organisms of sepsis?

Answer 19

Neisseria meningitides
Streptococcus pneumoniae
Staphylococcus aureus
Group A and B streptococcus
Escherichia coli

Question 20

Who is at increased risk of sepsis?

Answer 20

• Neonates and young babies under 3 months
• Premature babies
• History of intrapartum pyrexia or prolonged rupture of membranes (over 1 day)
• Maternal colonisation with Group B streptococcus
• Immunocompromised children

Question 21

What are some differentials for sepsis in children?

Answer 21

• Uncomplicated infection e.g. vial URTI can mimic sepsis
• Leukaemia and aplastic anaemia
• Malignancies
• Juvenile idiopathic arthritis - can mimic infection, rashes and swollen joints, fever
• Kawasaki disease - rash, conjunctivitis, cervical lymphadenopathy