Pediatric Sepsis

Sepsis is the number one killer of children and infants worldwide. In the United States, 42,000 children develop sepsis each year resulting in 4,400 deaths.

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Causes of pediatric sepsis

In newborns and young infants, bacterial infections are almost always the cause of sepsis. Common infections such as e-coli infection, meningitis, pneumonia, Group B Streptococcus (GBS) infection, and salmonella poisoning can all lead to sepsis in infants. Infections can be passed from mother to child during pregnancy, labor, and delivery.

Who is at risk?

1. Unvaccinated babies and children are the most susceptible to infections, particularly between the ages of 2 months and 36 months when the immune system is not yet fully developed.

2. Infants in pediatric ICU and premature babies receiving neonatal intensive care are particularly at risk because their immune systems are underdeveloped or compromised. The entry point for tubes such as catheters and intravenous (IV) lines can provide a path for bacteria, some of which normally live on the skin’s surface, to get inside the baby’s body and cause an infection.

doctor-measures-the-pressure-of-a-pregnant-woman-000024367008_Large3. Certain complications in pregnancy, labor and delivery can result in bacteria entering the baby’s body from the mother and increase the risk for sepsis in newborns.

These include:

  • Maternal fever during labor
  • An infection in the uterus or placenta
  • Premature rupture of the amniotic sac (before 37 weeks of gestation)
  • Early rupture of the amniotic sac during labor (18 hours or more before delivery)
  • Mother has Group B Streptococcus bacteria, which can be passed on to the child during labor

Signs and Symptoms

Sepsis in newborns can produce a variety of symptoms. Often, these babies “just don’t look right” to their caretakers.
Symptoms of sepsis in newborns and young babies include:

  • Disinterest or difficulty feeding, or vomiting
  • Fever (above 100.4°F [38°C] or higher rectally) or sometimes low temperatures
  • Irritability or increased crankiness
  • Lethargy (not interacting and listless)
  • Changes in heart rate — either faster than normal (early sepsis) or significantly slower than usual (late sepsis, usually associated with shock)
  • Breathing very quickly or difficulty breathing
  • Periods where the baby seems to stop breathing for more than 10 seconds (apnea)
  • Change in skin color — becoming pale, patchy, and/or blue
  • Jaundice (when the skin and eyes look yellow)
  • Rash
  • Decreased amount of urine
  • Bulging or fullness of the soft spot on the baby’s head

Older infants and children who have sepsis might have:

  • Fever
  • Vomiting
  • Rash
  • Change in skin color
  • Trouble breathing
  • Racing heart
  • Lethargy, irritability, or confusion.

A child with sepsis may have started with an infection such as cellulitis or pneumonia that seems to be spreading or getting worse.

Diagnosing and Treating Sepsis

Sepsis must be treated in the hospital, usually through antibiotics transmitted intravenously. If sepsis is suspected, doctors may start administering antibiotics immediately, before the diagnosis is confirmed. This is because time is a crucial factor in ensuring a positive outcome from sepsis. If necessary, babies may also receive IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.

Laboratory tests play a crucial role in confirming or ruling out sepsis in infants. These include:

  • Blood tests (including white blood cell counts and blood cultures) are done to see whether bacteria are in the blood.
  • Other blood tests may be performed to ascertain how certain organs, such as the liver and kidneys, are functioning.
  • A urine test to check for bacteria.
  • A lumbar puncture (also called a spinal tap), depending on the baby’s age and overall appearance. Spinal fluid is tested to check for meningitis, an infection of the membranes covering the brain and spinal cord.
  • X-rays, especially of the chest can be taken to check for pneumonia.
Doctor giving a child an intramuscular injection in arm, shallow DOF

Preventing Pediatric Sepsis

While sepsis cannot be prevented entirely, likelihood of developing sepsis is reduced by:

    • Preventing the transmission of GBS bacteria from mother to child during childbirth. Pregnant women can have a simple swab test between the 35th and 37th weeks of pregnancy to determine if they carry the GBS bacteria. If a woman tests positive for GBS, she can receive intravenous (IV) antibiotics during labor.RSF Kid washing hands
    • Providing IV antibiotics to during labor to women with a fever, a prematurely ruptured amniotic sac, or another child with sepsis or an infection such as pneumonia or meningitis.
    • Vaccinations and immunizations for infants and the adults handling them
    • Regular hand-washing

If your infant is less than 3 months old, has a rectal temperature of 100.4°F (38°C), seems lethargic, irritable, uninterested in eating, having difficulty breathing or appears ill, take your baby to see a doctor immediately.

In older babies and children, call your doctor immediately if your child exhibits symptoms including fever, irritability, difficulty breathing, and lethargy. A child may also seem irritable, confused, have trouble breathing, have a rash, appear ill, or may complain that his or her heart feels like it’s racing.