Sepsis in Children

Sepsis in children is one of those areas that always frustrates me slightly. In adults, sepsis  care is improving and we have clear criteria for diagnosing sepsis. Diagnosing sepsis in children is a little bit harder - and it can be a fine line between a nasty infection, and sepsis. There are probably three important sections to consider under the "sepsis" banner:

• Fever in children
• Meningococcal septicaemia
• Sepsis identification and treatment 

Mortality from paediatric sepsis ranges from 9% to 35%. Aggressive fluid resuscitation early in the course of SIRS results in decreased mortality. The risk of sepsis is inversely related to age. Neonates are at the highest risk, with bacterial sepsis occurring in 1-10 per 1000 live births in the United States.

Risk Factors
- Children with sickle cell have a 400-fold increased risk of sepsis due to pneumococcus and salmonella.  am
- Severe sepsis 15% more common in boys.

Pathogenesis
In children, shock is more likely to be associated with profound hypovolaemia. They often need more aggressive fluid resuscitation than adults.

Recognition of Sepsis

The NICE traffic light guidelines on feverish illness provide a useful structure for assessing children.
Colour - normal, pale, mottled, ashen or blue?
Activity - responds normally, not responding to social cues, appears ill to an HCP
Respiratory - any signs of respiratory distress?
Circulation - any signs of dehydration?
Other - any amber signs, fever for more than 5 days, swelling of a joint

The college has clear standards for managing sepsis and meningitis in children, and fever in children which will be looked at in more detail when we get to the "fever" section.