Paediatric Sepsis

Question 1

SEPSIS definition for children

Answer 1

SIRS: (systemic inflammatory response syndrome)
At least two of: temp high/ low, HR high, breathing rate high, WCC high/ low (53% have infection)

Sepsis: SIRS + suspected/ proven infection

Severe sepsis: sepsis + organ dysfunction (CVS or resp or 2+ other organs) = shock

-> death

Question 2

How to manage sepsis in children

Answer 2

Recognise decreased mental status & perfusion - begin high flow O2 and establish IO/ IV access according to PALS

• if no hepatomegaly or rales/ crackles push 20mL/ kg isotonic saline boluses & reassess after each bolus up to 60 mL/ kg until improved perfusion
• correct hypoglycaemia/ hypokalaemia
• begin antibiotics

Fluid refractory shock:
- begin peripheral IV/ IO inotrope infusion, epinephrine for cold shock and norepinephrine for warm shock

Catecholamine- resistant shock:
If at risk absolute adrenal insufficiency consider hydrocortisone, advanced monitoring: direct fluid, vasopressor/ vasodilator

Question 3

5 algorithmic time specific goals

Answer 3

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

Question 4

High risk criteria for sepsis in children under 5

Answer 4

No response social cues, appears ill, 
does not wake, 
weak high pitched crying, 
HR <160 under 1, 2-3 <150, 3-4 <140, RR under 1 60+, 1-2 50+, 3-4 40+,
Grunting, 
apnoea, 
O2 sat <90%, 
mottled, cyanosis, 
non-blanching rash, 
<36dc

Question 5

Management of high risk sepsis in children under 5

Answer 5

Immediate review sensor clinical decision maker

Venous blood test for:
Blood gas (glucose & lactate)
Blood culture
FBC
CRP
Urea, electrolytes
Creatinine
Clotting screen 

Give IV antibiotics <1hr
Take lactate
Give IV fluid

Question 6

Moderate to high risk criteria of sepsis in children under 5

Answer 6

Not responding social cues, 
No smile,
Wakes with prolonged stimulation,
RR under 1 50-59, 1-2 40-49, 3-4 35-39
O2 sat <91%
Nasal flaring
HR under 1 150-159, 1-2 140-149, 3-4 130-139

Capillary Refill time 3secs+
Reduced urine outlut
Pale/ flushed
Leg pain 
Cold hands/ feet

Question 7

Management of moderate to high risk sepsis in children under 5

Answer 7

X2 risk factors: 
Tests venous blood:
Blood culture
FBC
CRP
U&Es
CreatinineBlood gas
Lactate
Lactate >2 assesses as AKI 
Consider antibiotics <3hrs
Review <1hr

X1:
Review <1hr
Consider taking bloods
Manage

Question 8

Low risk criteria of sepsis for children under 5

Answer 8

Response normally social cues

Content/ smiles

Stay awake, wakens quickly

Strong normal cry or not crying

No high risk/ moderate criteria

Normal colour

Question 9

Management low risk sepsis children under 5

Answer 9

Clinical assessment & manage according to clinical judgement

Question 10

NICE sepsis ABCDE

Answer 10

Appearance
Breathing
Circulation
Demeanour
Exposure

Question 11

Paediatric sepsis 6 for managing sepsis

Answer 11

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

Question 12

Antibiotics for sepsis children

Answer 12

Age <1month
Gentamicin
Amoxicillin
Cefotaxime

1-3months
Amoxicillin
Ceftriaxone

> 3months
Ceftriaxone