Sepsis

Question 1

What are common causes of sepsis in children?

Answer 1

Coagulase negative Staphylococcus (Staph epidermis)
Staphylococcus aureus
Non-pyogenic streptococci
Streptococcus pneumonia

Neisseria meningitides

Question 2

What causes early onset sepsis in neonates? Late onset?

Answer 2

Group B streptococcus (Strep agalacticae)
E. coli

Coagulase negative staph

Question 3

What are clinical features of paediatric sepsis?

Answer 3

Fever
Poor feeding
Miserable, irritable, lethargy
History of focal infection e.g. meningitis, osteomyelitis, gastroenteritis, cellulitis
Predisposing conditions e.g. sickle cell, immunodeficiency

Tachycardia
Tachypnoea
Low blood pressure
Non-blanching purpuric rash (meningococcal septicaemia)
Multiorgan failure

Question 4

What are red flags for paediatric sepsis?

Answer 4

Hypotension
Lactate > 2mmol/L
Extreme tachycardia/tachypnoea
SpO2 < 90%/grunting/cyanosis/apnoea
P or U on AVPU
Immune compromised
Non-blanching rash/mottled skin

Question 5

What children are at risk?

Answer 5

Core temperature of <36 or >38.5 (38 if immunocompromised)
Tachycardia
Altered mental state (sleepiness, irritability, lethargy, floppiness)
Prolonged capillary refill time >2s

Question 6

What is the paediatric sepsis 6?

Answer 6

Within 60mins:

High flow oxygen

Obtain IV/IO access and take blood tests:

• Blood gas and lactate (±FBC, U&E, CRP)
• Blood glucose (treat hypoglycaemia 2mls/kg 10% glucose)
• Blood cultures

Give IV or IO ABX

Consider fluid resuscitation

• Aim to restore normal physiological parameters and UO > 0.5mls/kg/hr
• Give 10-20ml/kg isotonic fluid over 5-10mins
• Repeat as necessary, monitor UO

Involved senior clinicians early

Consider Inotropic support Early
- If normal physiological parameters not restored after >40ml/kg fluids, consider ICU admission

Question 7

What fluid resuscitation in children?

Answer 7

Titrate 20ml/kg isotonic 0.9% saline over 5-10mins

Aim to reverse shock
Repeat
Assess for fluid overload after > 40ml/kg fluids

IF normal physiological parameters not restored after >40ml/kg fluids, consider inotropic support and ICU admission

Question 8

What empirical antibiotics?

Answer 8

Refer to local guidelines

Depends one if immunocompromised, risk of resistance gram negative organism
and whether possible CNS infection or under 1 month of age

Tazocin (piperacillin/tazobactam)
Meropenem
Cefotaxime

+Vanc if MRSA positive or central venous line infection

Question 9

What are risk factors for resistant gram negative infection?

Answer 9

Prolonged hospital stay (current or in past)

Multiple prolonged courses of antibiotics

Question 10

What inotropic support?

Answer 10

Adrenaline (reconstitute whilst administering 3rd fluid bolus)
0.3mg/kg in 50mls 5% dextroe
Commence 1ml/hr = 0.1mcg/kg/min

Question 11

What if IV access cannot be obtained?

Answer 11

Intraosseous access
Anteromedial aspect of proximal tibia
Provides access to the marrow cavity and circulatory system