Paediatric Infectious Diseases 1 & 2 Flashcards
How many respiratory infections will the average school child have a year?
8-12
What are the signs of sepsis in a child?
1) Breathing quickly
2) Fit or convulsion
3) Mottled, bluish or pale
4) Has a rash that does not fade when you press it
5) Is very lethargic or difficult to wake
6) Feels abnormally cold
What are the signs of sepsis in a child under 5?
1) Is not feeding
2) Vomiting repeatedly
3) Has not urinated fo 12 hours
What are the signs of meningitis in a baby?
Refuse feeds
Be irritable
Have a high-pitched cry
Have a stiff body or be floppy or unresponsive
Have a bulging soft spot on the top of their head
How do mortality rates for children and young people in the UK compare with those of other high income countries?
Mortality outcomes for C&YP in the UK are considerably worse than comparable high income countries
The UK ranks in the bottom 3 countries in the EU15+ for mortality from common infections in both sexes and across all age groups
Mortality from treatable infection in the UK is almost 2x that of our best performing European neighbours
What proportion of sepsis cases worldwide occurr in children?
>1/2
When is the peak incidence for sepsis?
Early childhood (<1y)
What is the fatality rate of child sepsis?
10%
What is sepsis?
SIRS + suspected or proven infection
What is severe sepsis?
SIRS + suspected or proven infection
What is septic shock?
Sepsis + CVS dysfunction
What is SIRS?
Systemic inflammatory response syndrome
What constitutes SIRS?
What are normal NEWS RR and HR for a child 12-23 months?
RR - 25-40
HR - 100-150
Describe the traffic light system in assesseing children
What is the criteria for commencing sepsis 6 in a child?
If you suspect sepsis, what must you do? (1)
If you suspect sepsis, what must you do? (2)
What makes recognising sepsis in a child <3 months difficult?
- May have minimal signs & symptoms
- Presentation often non-specific
- May not mount a febrile response (~50%)
What makes recognising sepsis in a child <3 months important?
- Increased risk bacterial infection
- Increased risk sepsis
- Increased risk meningitis
- Deteriorate quickly
What are risk factors for sepsis in a child <3 months?
- Prematurity (< 37/40)
- Premature ruptuer of membranes (PROM)
- Maternal pyrexia/chorioamnionitis
- Maternal GBS (this pregnancy) - Group B Streptococcal Septicaemia??
- Previous child with GBS
- Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
How must you manage paediatric sepsis?
- Airway
- Breathing
- Circulation – 20ml/kg fluid bolus
- DEFG –‘don’t ever forget glucose’
- 2ml/kg 10% dextrose
- Antibiotics
- 3rdgeneration cephalosporin (e.g. Cefotaxime/Ceftriaxone)
- Add IV Amoxicillin if <1m old
What are the blood tests done in sepsis?
- FBC (leukocytosis, thrombocytopaenia)
- CRP
- Coagulation screen (DIC)
- Blood gas (metabolic acidosis, raised lactate)
- Glucose
- Blood culture
What are the cultures done in sepsis?
- Blood
- Urine
- CSF (including send to virology)
- +/- stool (micro + virology)
What imaging is done in sepsis?
CXR
What are the organsims liekly to be responsible neonates <1 month?
- Group B Streptococcus
- E. coli
- (Escherichia coli)
- Listeria monocytogenes
What are the organsims liekly to be responsible older infants and children?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Group A Streptococcus
- Staphylococcus aureus
Describe the pathogenesis of sepsis
- Secretion ofpro and anti-inflammatory cytokines
- Activation of complement
- Activation and mobilisation of leukocytes
- Activation of coagulation and inhibition of fibrinolysis
- Increased apoptosis
Summary
- Sepsis is a major cause of death in children
- Early recognition improves survival
- Important to think ‘could this be sepsis?’
- Respond appropriately
- If you’re not sure ask!
- Follow guidelines!
- Paediatricians want to know about any child <3m old with fever
