Lecture notes Acute Care (SHN2004)

SHN2004 (Acute Care) – Paediatric Sepsis


Paediatric Sepsis
Session outcomes
 Background
o Why and how it affects children differently
 Assessment
o ABCDE Assessment
o Sepsis 6 Tools
 Treatment and management

Background
 Sepsis is a potentially life-threatening condition whose mortality and morbidity can
be reduced by prompt identification and treatment.
o If you think there is the slightest possibility that it could be sepsis voice your
concerns.
 Use your clinical judgement and experience
 Severe infection resulting in sepsis is recognized as a leading cause of morbidity and
mortality in children worldwide (almost 60% of all deaths in children under five).
 25,000 children are affected by sepsis each year in the UK
 1/4 of all sepsis survivors suffer permanent, life-changing after effects
 5 people are killed by sepsis every hour in the UK

What makes children ill?
 Every child will have multiple episodes of infection during the first years of life
o This has been temporarily suppressed since Covid Restriction were put in
place in 2020. However for Winter 2021/22 NHS is expecting a spike in
respiratory illness as previous restrictions have been lifted
 Most commonly respiratory and gastrointestinal viral infection
 The majority of which are self-resolving, however we need to spot those that are at
risk of developing sepsis

How is sepsis different?
 Initial symptoms of sepsis are often non-specific and may include fever, cough, sore
throat, vomiting and diarrhoea.
 As the illness progresses, any combination of the following signs and symptoms may
develop:
o Shivering
o Fever or feeling very cold
o Extreme pain or discomfort
 Noises they make are different – e.g. a change in their cry from the
norm (e.g. change in pitch, longevity)
o Clammy or sweaty skin

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, SHN2004 (Acute Care) – Paediatric Sepsis


o Confusion or disorientation
o Shortness of breath
o High heart rate (tachycardia)

What is Sepsis?
 Sepsis is a rare but serious medical condition that results from the body’s
overwhelming response to an infection.
 Sepsis is a collection of physiological responses to infection, which involves the
immune system and is characterised by a process known as inflammation.
 In sepsis, the delicate balance between pro-inflammatory and anti-inflammatory
cytokines, which should regulate the process, becomes disordered.
 Sepsis is inflammation ‘gone bad’ (become disordered and escalated)

The Sepsis Process
 Sepsis is a common and potentially life-threatening condition triggered by an
infection
 Stage 1: Infection
o Infection occurs when microbes invade the body tissue and is common.
o Pathogens enter from the lungs, bladder or intra-abdominally.
o In neonates the commonest entry point is vascular access.
o Staphylococcal infections are the commonest infection progressing to sepsis.
Bacteria replicate in blood and release toxins, stimulating the immune
system.
 Stage 2: Sepsis
o Sepsis occurs when infection produces a response within the body sufficient
to cause potentially life-threatening organ dysfunction.
o The initial clinical presentation of sepsis in children may be non-specific,
especially in younger age groups
o Without prompt, effective treatment it can cause severe illness leading to
death or long-term disability.
o Treatment includes controlling the source of the infection and giving
appropriate antibiotic treatment.
 This can occur even before admittance to hospital – e.g. if the child
has been taken to the doctors by parents.
 Stage 3: Septic shock
o Septic shock occurs when this response results in a lowering of blood
pressure requiring specific treatments to maintain adequate perfusion.
o Septic shock is an important sub-group of sepsis as it has a significantly
increased mortality and requires prompt intervention from clinicians.
o Acute respiratory failure is the commonest organ system failure in children
with sepsis.

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