Sepsis in Children

Introduction

Sepsis is a clinical syndrome resulting from bacterial blood stream infection with active proliferation of the organisms.
Early-Onset sepsis manifests within the first 48 hours of life or at most 7 days of life while
Late-Onset sepsis manifests after 7 days of life.
Terminologies.
Early-Onset sepsis is presumed when risk factors for sepsis are present but the
infant has no clinical feature suggestive of sepsis.
In probable sepsis, an infant has clinical
and/or laboratory features suggestive of
sepsis without bacteriological
confirmation.
Sepsis is latent when clinical features are
present with laboratory features such as
deranged full blood count or elevated
serum C-Reactive Proteins and serum
Interleukins but without positive blood
culture.
Sepsis is confirmed when blood culture is positive in addition to clinical
manifestations.

Clinical Features

  • Non-specific features include fever,
    vomiting, poor feeding, poor activity
  • More specific features include hypothermia, poor skin color, jaundice, abdominal distension, respiratory distress, apnea and
    bleeding tendencies.
  • There may be local manifestations of serious illnesses such as omphalitis, otitis media, pneumonia, diarrhoea or urinary tract infestation.

Investigations

  • Anaemia, leucopaenia, thrombocytopaenia, elevated C Reactive Protein, elevated procalcitonin, elevated interleukins 1,6,8 and positive blood culture.
  • Others will include specific ancillary tests for localized diseases
    such as chest X-Ray, mid-stream urine and other swabs for bacteriological studies.

Management

For presumed sepsis in the
developing world, it is recommended
that blood culture should be requested
and the infant is immediately
commenced on empirical antibiotic
therapy based on the local pattern of
organisms and their sensitivity pattern.
Intravenous cefuroxime 50mg/kg 12
hourly and gentamicin 2.5mg/kg 12
hourly.
The infant should be closely monitored for any evidence of clinical deterioration.
If the infant remains asymptomatic and the blood culture yields no growth, the antibiotics can be safely discontinued after 48 hours.
For probable sepsis, blood culture
should be requested while the infant is commenced on antibiotics:

  • intravenous second or third generation cephalosporins;
    • Cefuroxime 50mg/kg 12-hourly or
    • Ceftriaxone 75mg/kg daily or
    • Cefotaxime 50mg/kg 8-hourly

and

    • gentamicin 2.5mg/kg 12-hourly for 10 to 14 days depending on the clinical response.

It may be necessary to change the antibiotics if the sensitivity report
from the laboratory suggests resistance to the drugs in use.

Support care:

  • Fluid and caloric balance, dextrose for hypoglycaemia, blood transfusion for severe anaemia,
    oxygen therapy and ventilators supports for hypoxaemia.