Pediatric Sepsis: Symptoms, Diagnosis & Treatment
As with adults, when babies and children develop an infection, their immune systems fight the invading culprit, whether it’s bacteria, a virus, or a fungus. But sometimes the immune system’s response to an infection can spin out of control, leading to a life-threatening condition called sepsis. Sepsis occurs when the body’s response to an already-present infection gets out of hand, leading to severe inflammation throughout the body that, in turn, can cause tissue damage and organ failure. When organs begin to stop functioning, the body can enter a stage of sepsis called “septic shock,” and the threat of death is imminent.
While sepsis is a serious condition at any age, it is particularly dangerous for children because their symptoms can be more difficult to detect. “The biggest difference between adult and pediatric sepsis is recognition,” says Yale Medicine pediatric intensive care doctor Sarah Kandil, MD. “A lot of symptoms we look for in sepsis, like a fever, are similar to other illnesses in children.”
Though pediatric sepsis is unusual, it’s not all that rare either. Studies estimate that more than 75,000 children are treated for severe sepsis each year in the U.S.
Sepsis can develop from an injury as simple as an infected scrape on the arm, or it can emerge on top of an already life-threatening condition, such as acute appendicitis. “Those who have a weakened immune system, like kids undergoing chemotherapy, can be especially susceptible,” Dr. Kandil says.
Besides being more difficult to detect in children, parents, caregivers, and even medical staff may not have enough knowledge about the signs of sepsis. “We have an ongoing campaign in at Yale New Haven Children’s Hospital that encourages medical providers and families to be aware of sepsis,” Dr. Kandil says.
All Yale Medicine’s pediatric care providers are trained to recognize the early signs of sepsis in children, in order to provide quick and accurate care to interrupt the condition’s progress.
Who is at risk of developing sepsis?
Any child can develop sepsis. However, premature babies and infants can be especially susceptible to the condition because their immune systems are still developing. Neonatal sepsis refers to a type of sepsis that develops in babies from just after their birth up through the first 90 days of their lives. If symptoms develop within six hours after birth (early-onset neonatal sepsis), then the infection is likely one that was passed on from mother to child during the course of pregnancy.
Some examples of these types of infections include group B streptococcus (GBS) and E. coli—both of which can exist naturally in vaginal cultures of women. For sepsis that develops after that window (called late-onset neonatal sepsis), infections are usually contracted from the environment. In hospitals, the infections can come from catheters or any other medical devices that remain in the baby’s body for a period of time. Viral-induced sepsis is also possible and can be caused by an adenovirus or enterovirus (both are types of viruses that can cause mild to severe illnesses).
In general, children who are already hospitalized for an infection, such as a burst appendix or a urinary tract infection, are at a higher risk of sepsis.
What are the signs of pediatric sepsis?
Part of the reason sepsis can turn into a serious condition is because it is difficult to detect early in children. For example, in adults, two of the telltale signs of sepsis include a rapid heartbeat and low blood pressure. Those symptoms look different in kids. “Children have less cardiac reserve than adults and compensate differently,” Dr. Kandil says, referring to the difference between the amount of blood a heart pumps at a given time and its maximum capacity for pumping blood. “This means their blood pressure might decrease only much later in the sepsis process,” she says.
On top of being difficult to recognize, sepsis is a secondary medical condition that develops after an initial infection, and its symptoms can mimic those of the original illness. Some signs of sepsis can include the following:
- Lethargy or being “sleepier” than normal
- General pain or discomfort
- Nausea and vomiting
Unlike some medical conditions that produce consistent symptoms across the general population—the flu virus, for example—sepsis symptoms can vary according to each individual, and this makes the value of diagnostic testing all the more important.
How is sepsis diagnosed?
A single diagnostic test for sepsis does not yet exist. Doctors and healthcare professionals use a combination of tests to piece together a full picture of the infection. They will likely order blood and urine tests, as well as tests for specific bacterial infections or inflammation. A spinal fluid test, X-ray, or ultrasound may also be needed.
Urine samples can provide information about urinary tract infections (UTI) or kidney problems. Blood tests can also highlight the condition, showing markers of inflammation or circulation problems, such as the following:
- Elevated or low white blood cells – Higher than usual levels of leukocytes, known as white blood cells (WBCs), are a sign of a current infection, while too few WBCs indicate that a person is at higher risk of developing one.
- Lactic acid – When organs and muscles do not receive enough oxygen, they can release lactic acid. High levels of this in the blood can indicate that sepsis is present.
- C-reactive protein (CRP) – The body produces this type of protein during periods of severe inflammation.
What treatment options are available for sepsis?
Infants and children who have developed sepsis—and most especially those who have progressed into septic shock—are usually transferred to a hospital’s intensive care unit. There they will be closely monitored and may require specialized equipment such as ventilators for support. In addition to stabilizing vital signs (like breathing rate, blood pressure, and body temperature), doctors can treat sepsis with intravenous fluids, antibiotics, and other medications as needed. “With sepsis, you treat the infection, but you also have to support the body through this ‘immune storm’ that it’s going through,” says Dr. Kandil.
How can sepsis be prevented?
The best ways to fight sepsis in infants and children is to prevent an infection from occurring in the first place. Broadly, here are some ways this can be accomplished:
- Frequent hand-washing. This helps prevent the introduction of germs into the body. There are few other first-line defenses as well-studied and well-supported as hand-washing to prevent infections.
- Vaccines. Today, some of the recommended vaccines for newborns (e.g., the diphtheria-tetanus-pertussis [DTP3], measles, and polio vaccines) are given specifically to prevent infections.
- Act quickly. The earlier a child receives care for an infection that is not improving, the greater the chances are that sepsis can be avoided.
Can kids make a full recovery from sepsis?
The earlier that sepsis is detected and treated, the greater chance a child has to make a complete and total recovery. “There is a spectrum of recovery,” Dr. Kandil says. “This depends on if any complications occurred during sepsis, or if it progressed to later stages and resulted in organ damage.”
How does Yale Medicine approach treatment of children with sepsis?
Yale New Haven Children’s Hospital is part of a national collaborative dedicated to raising awareness around the recognition and early treatment of sepsis. “We are working with nurses, pharmacists, and epidemiologists and tracking our outcomes to see if we can make a difference,” Dr. Kandil says. “The goal is to have earlier recognition and to improve outcomes.”