Paediatric Sepsis

Question 1

Define adult sepsis.

Answer 1

An infection that leads to a dysregulated host response, causing life threatening organ dysfunction.

Question 2

Define child sepsis.

Answer 2

Systemic inflammatory response syndrome leads to sepsis which can cause severe sepsis.
SIRS have at least 2 of:
1. High/low temperature,
2. High heart rate,
3. High breathing rate,
4. WCC high or low.
Sepsis is SIRS+suspected/proven infection.

Question 3

What is severe sepsis?

Answer 3

Sepsis+ organ dysfunction (cardiovascular, resp or 2 or more other organs). If cardiovascular causes septic shock.

Question 4

If a child has Systemic Inflammatory Response Syndrome do they have an infection?

Answer 4

No, occurs in 50% of the time.

Question 5

Describe sepsis epidemiology.

Answer 5

7% mortality overall.
11% neonate mortality, 3% that were previously well died and 7% with other comorbidities.
Mortality is worst if you have organ dysfunction (severe septic shock).

Question 6

What are the time-specific goals for childhood sepsis?

Answer 6

1. Early recognition of severe sepsis.
2. Vascular access.
3. Antibiotic administration.
4. Administering IV fluids.
5. Vasopressin for fluid refractory shock.

Question 7

What is NCEPOD?

Answer 7

National Confidential Enquiry into Patient Outcome and Death looked into sepsis death in children in 2015-2016.

Question 8

What are the risk factors for sepsis?

Answer 8

1. Age <1yr.
2. Impaired immunity.
3. Recent trauma/surgery/skin breach.
4. Indwelling lines/catheters/devices.

Question 9

Describe the NICE childhood sepsis risk approach.

Answer 9

If high risk: review, take bloods, give antibiotics within 1 hr, measure lactate, maybe give a fluid bolus/consult with consultant.
If Moderate risk: take bloods and review, decide whether to give antibiotics in an hour.
If low risk: manage.
Consider the ABCDE.
Appearance.
Breathing.
Circulation.
Demeanour.
Exposure.

Question 10

What does raised lactate indicate?

Answer 10

Increased risk of mortality.

Question 11

How should capillary refill time be interpreted?

Answer 11

Compare peripheral and central refill, but it does have low diagnostic value for sepsis. It is helpful with whole assessment.

Question 12

Does normal temperature reassure?

Answer 12

No, low suggests increased mortality.

Question 13

How should sepsis be recognised?

Answer 13

Lows unwell.
Clinical/parental concern.
Raised Early Warning Score (EWS). High temp not needed.

Question 14

What is the Paediatric Sepsis 6?

Answer 14

1. Give high flow O2.
2. Obtain IV/IO access and take blood tests.
3. Give IV/IO antibiotics.
4. Consider fluid resuscitation (refer to lactate).
5. Involve senior clinicians/specialists early.
6. Consider inotropic support early.

Question 15

What antibiotics should be given to a <1month year old with sepsis?

Answer 15

Gentamicin.
Amoxicillin.
Cefotaxime.

Question 16

What antibiotics should be given to a child aged 1-3 months with sepsis?

Answer 16

Amoxicillin.

Ceftriaxone.

Question 17

What antibiotic should be given to a child older than 3 months with sepsis?

Answer 17

Ceftriaxone.