Clinical Review

Sepsis in children

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3017 (Published 09 June 2015) Cite this as: BMJ 2015;350:h3017

This article has a correction. Please see:

  1. Adrian Plunkett, consultant paediatric intensivist1,
  2. Jeremy Tong, consultant paediatric intensivist2
  1. 1Birmingham Children’s Hospital, Birmingham, UK
  2. 2University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to: A Plunkett adrian.plunkett{at}bch.nhs.uk

The bottom line

  • The initial clinical presentation of sepsis in children may be non-specific (especially in younger age groups)

  • Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded

  • Progression to organ failure and shock is often rapid, so early recognition and treatment is crucial

  • Apart from antibiotics, there are currently no specific treatments of proved value

  • Other treatment after antibiotics is supportive and should be delivered according to internationally recognised, consensus based guidelines

Sepsis is a clinical syndrome resulting from a dysregulated systemic inflammatory response to infection.1 It is characterised by a generalised pro-inflammatory cascade, which may lead to widespread tissue injury.2 It encompasses a clinical spectrum of severity, including severe sepsis, septic shock, and multi-organ failure.3 Sepsis is a leading cause of morbidity and mortality in children worldwide.4

International consensus guidelines define sepsis as the presence of systemic inflammatory response syndrome plus suspected or proven infection.3 A more pragmatic definition of sepsis has been proposed—that sepsis is a systemic response to infection with the presence of some degree of organ dysfunction.5 This definition is not currently widely accepted, but new criteria are under discussion and due to be published later in the year.

What is the epidemiology?

Global data on sepsis in children are incomplete, but it is estimated that infection accounts for most deaths (almost 60%) in children aged under 5 years.4 The World Health Organization has stated that the four big causes of death in children worldwide are infectious diseases: pneumonia (1.9 million deaths/year), diarrhoea (1.6 million deaths/year), malaria (1.1 million deaths/year), and measles (550 000 deaths/year).6

The largest epidemiological reports of the incidence …

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