SEPSIS – assessment and management

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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

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    See also

    Antibiotics guideline
    Febrile neutropenia guideline
    Febrile child guideline
    Intravenous fluid guideline
    Intraosseous access guideline

     Key Points

    1. Clinician judgement is the best performing tool for early recognition of paediatric sepsis; vital signs are dynamic and prone to confounding, hypotension is a late sign, and screening blood tests have not been validated.
    2. Initial management includes obtaining intravenous access, sampling for blood culture and venous blood gas, and early administration of empiric intravenous antibiotics.
    3. Fluid resuscitation should be titrated carefully to avoid the harms associated with inadequate and excessive administration.
    4. Inotropes and vasopressors may be safely administered via peripheral intravenous cannula in children during initial resuscitation.

    Background to condition

    Treatment priorities:

    • Early administration of empiric intravenous antibiotics
    • Carefully titrated fluid resuscitation
    • Peripherally administered inotrope / vasopressor

    Common pathogens in infants <3 months of age:

    • E. coli
    • Group B streptococci 
    • Listeria is uncommon  

    Common pathogens in older children:

    • Neisseria meningitidis
    • Streptococcus pneumoniae
    • Staphylococcus aureus
    • Group A streptococci
    • Community acquired MRSA is becoming more common  

    High risk groups include:

    • Neonates
    • Immunocompromised children
    • Children with central venous access devices  

    Septic children may present with:

    • cold shock characterised by a narrow pulse pressure and prolonged capillary refill. The underlying haemodynamic abnormality is septic myocardial dysfunction, which is more common in infants and neonates.
    • warm shock characterised by a wide pulse pressure and rapid capillary refill. The underlying haemodynamic abnormality is vasoplegia, which is more common in older children and adolescents.  

    In some settings fluid resuscitation may be harmful, and should be considered in the same way as any other intravenously administered medication, with the potential benefits and harms for the individual patient considered prior to administration.  

    In an unwell child, resuscitation should not be delayed by procedures such as urinalysis and lumbar puncture. These procedures should, however, be performed as soon as possible once the child has been stabilised.

    Assessment and management 

    Early Management of Paediatric Sepsis

    When to consider transfer

    • Any child who has received 40ml/kg or more of IV fluids as a bolus should be discussed with PIPER.
    • Child requiring care beyond the comfort level of the hospital. 

    Information specific to RCH - Including who to consult for inpatients.
    If you are worried about the patient ring ICU x55211 / PICU outreach registrar x52327 / or call a MET 777.

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Last revised January, 2017