Sepsis

Question 1

What are the signs and symptoms of sepsis?

Answer 1

Sepsis = SIRS in the presence of infection

SIRS criteria ≥2 of the following (abnormal temp/WCC must be present):

• Abnormal core temperature (<36 or >38.5°C)
• Abnormal HR (>2 S.D. above normal for age, or less than 10th centile for age if child aged < 1 years)
• Raised RR (>2 S.D. above normal for age, or mechanical ventilation for acute lung disease)
• Abnormal WCC in circulating blood (above or below normal range for age, or >10% immature cells)

Red-flag Sepsis = clinically based criteria to diagnose a high-risk sepsis -> immediate sepsis 6 pathway

• Hypotension
• Blood lactate >2mmol/L
• Prolonged capillary refill >5 seconds
• Pale/mottled or non-blanching (purpuric) rash
• Oxygen needed to maintain saturations >92 %
• RR >60 min-1 or >5 below normal, or grunting
• AVPU = V, P or U
• Abnormal behaviour (e.g. Excessively dry nappies, lack of response to social cues, significantly decreased activity, weak, high-pitched or continuous cry)

Question 2

What are some causative organisms?

Answer 2

• GBS and Escherichia coli, L. monocytogenes -> early onset neonatal sepsis
• Coagulase-negative Staphylococcus (CoNS) -> late onset neonatal sepsis (I.E. Staphylococcus epidermidis)
• Other causative organisms:
  > Staphylococcus aureus (Coagulase +ve)
  > Non-pyogenic streptococci
  > Streptococcus pneumoniae
  > Neisseria meningitidis

Question 3

What investigations should you do?

Answer 3

clinical suspicion (diagnosis cannot be delayed)
bloods

Risk factors for neonatal sepsis = PROM/PPROM, chorioamnionitis (i.e. fever during labour)

Question 4

WHta is the management for sepsis?

Answer 4

1. Paediatric sepsis 6 within 1 hour and transfer to acute setting (+ continuous monitoring, review hourly)
2. IV access (if failed after 2 attempts, gain IO access)
3. Review by ST4 or above (<30 minutes) and then a consultant (<1 hour)
4. LP in the following = <1 month old; 1-3 month who appear unwell; 1-3 month with WCC <5 or >15 x109/L
5. IV fluid resuscitation + 20mL/kg 0.9% NaCl bolus over 5-10 minutes
6. Bloods:
   • Clotting (as DIC can feature in sepsis)
   • VBG (including glucose and lactate) – quick
   • Blood culture
   • FBC
   • CRP (N.B. takes 12-24hrs to rise)
   • U&Es and creatinine
7. CXR, urine dipstick on MSU
8. Antibiotics (within 1hr) -> follow local guidelines:
   
   • If meningococcal sepsis:
     CoNS = Coagulase -ve Staphylococcus
     • IM benzylpenicillin (in the community)
     • IV cefotaxime (in hospital)
   • If other type of infection… GOSH child ABx treatment:
     Early onset <72 hours -> GBS, L. monocytogenes, E. coli -> IV cefotaxime + amikacin + ampicillin

Late onset >72 hours -> CoNS (S. epidermidis) -> IV meropenem + amikacin + ampicillin