sepsis and child mortality Flashcards

1
Q

how common is infection in paediatrics

A
  • common in children
  • avg pre-school child will have 8-12 resp infections p/a
  • likely to spend 3-5mths p/a w/ viral infection
  • majority due to viruses
  • majority self limiting and last 8-14 days
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2
Q

infections and admissions to hospital

A

39% of all acute paeds admissions

25% of GP OOH - 60% of these are 1-4y/o

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3
Q

UK child mortality (<5y/o)

A
  1. 27 per 1000 live births
  2. 4% or 1/ 234 children
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4
Q

problems with child mortality in UK

A
  • mortality outcomes are considerably worse than comparable HICs
  • UK ranks in bottom 3 countries in the EU15+ for mortality from common infectious in both sexes and across all age groups
  • mortality from treatable infection in UK - almost 2x that of best performing European neighbours

failure to recognise serious illness at the 1st point of healthcare contact is an important avoidable factor in child death

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5
Q

how many deaths does infection account for

A

16.2% deaths 1-4y/o

8% deaths 5-9y/o

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6
Q

causes of child death

A

infectious disease ~½ of all deaths

  • pneumonia, diarrhoea diseases, meningitis, malaria, measles

neonatal disorders

injuries and accidents

non-communicable diseases

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7
Q

how common is sepsis

A

severe sepsis is one of the leading causes of death in all children

>½ of all sepsis cases worldwide occurred in children

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8
Q

when is the peak incidence of sepsis

A

early childhood

  • infants <1y: 1 in 200
  • children 1-4: 1 in 2000
  • children 5-15: 1 in 5000
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9
Q

fatality from sepsis

A

10%

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10
Q

how to improve survival in sepsis

A

early recognition and appropriate treatment

  • UK: only 38% compliance w/ recommended treatment guidelines
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11
Q

what is sepsis

A

sepsis = systemic inflammatory response syndrome (SIRS) + suspected/proven infection

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12
Q

what is severe sepsis

A

severe sepsis = sepsis + organ dysfunction

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13
Q

what is septic shock

A

septic shock = sepsis = CVS dysfuntion

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14
Q

what is SIRS

A

≥ 2 of:

  • temp >38 or <36
  • WCC >15x 10^9/L or <5x 10^9/L
  • tachycardia >2SD above normal for age
  • tachypnoea >2SD above normal for age
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15
Q

paediatric normal values

A
  • faster HR as baby, slows gradually w/ age
  • faster RR as baby, slow gradually w/ age
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16
Q

traffic light system for fever <5y/o

A
  • helps identify high risk children
  • remember to take CRT centrally e.g. sternum
17
Q

changes in HR w/ temp

A

10bpm increase for every 1C is normal

18
Q

paeds sepsis signs

A

temp <36 or >38

inappropriate tachycardia

poor peripheral perfusion/CRT >2s/mottles

altered mental state - sleepiness, irritability, lethargy, floppiness

inappropriate tachypnoea

hypotension - very late sign in children

19
Q

when would we have a lower threshold for treating sepsis

A
  • infants <3mths
  • immunosuppresed/immunocompromised/chemotherapy/long term steroids
  • recent surgery
  • indwelling devices/lines
  • complex neuro-disability/long term conditions - observations may vary from their baseline
  • high index of clinical suspicion - tachypnoea, rash, leg pain, biphasic illness, poor feeding
  • significant parental concern
20
Q

sepsis 6 for paeds

A
  1. high flow oxygen
  2. IV/IO access and take blood test - blood cultures, blood glucose, blood lactate
  3. IV/IO abx: broad spectrum as per local policy

IF SHOCKED:

  1. consider fluid resuscitation
  2. consider inotropic support early - adrenaline
  3. senior/specialist involvement early
21
Q

why do we have a lower treatment threshold for infants <3mths

A
  • increased risk of bacterial infection
  • increased risk of sepsis
  • increased risk meningitis
  • may have minimal signs and symptoms
  • presentation often non-specific
  • may not mount a febrile response (~50%)
  • deteriorate quickly
22
Q

what are the risk factors for infection in infants <3mths

A
  • prematurity (<37/40)
  • prolonged rupture of membranes
  • maternal pyrexia/chorioamnionitis
  • maternal group B strep (this pregnancy)
  • previous child w/ group B strep
  • maternal STI - chlamydia, gonorrhoea, syphilis, HSV
23
Q

management of sepsis in children

A

Airway

Breathing

Circulation - fluid bolus (20ml/kg 0.9% NaCl)

DEFG - 2ml/kg 10% dextrose

abx - 3rd gen cephalosporin (e.g. cefotaxime/ceftriaxone), add IV amoxicillin if <1m/o

24
Q

investigations for sepsis in children

A

bloods - FBC (leucocytosis, thrombocytopaenia), CRP, coagulation screen (DIC), blood gas (metabolic acidosis, raised lactate), glucose, blood culture

cultures - blood, urine, CSF (incl to send to virology), +/- stool (micro + virology)

imaging - CXR (can be helpful to exclude focal pneumonia)

25
Q

causative organisms of sepsis in neonates (<1mth)

A

group B strep

Escherichia coli

listeria monocytogenes

26
Q

causative organisms of sepsis in older infants and children

A

streptococcus pnuemonia

Neisseria meningitidis

Group A streptococcus

Staphylococcus aureus

27
Q

pathogenesis of sepsis

A
  • overwhelming response to infection
  • bacterial infection triggers cytokine responses from endothelium and chemotaxis
  • LPS produced by bacteria also trigger complement activation and coagulation cascade activation
  • release of anti-inflammatory cytokines, disruption of coagulation cascade and activation of complement → impaired vascular permeability
28
Q

sss

A

sss