Sepsis

What is sepsis?

The body's immune system is responsible for fighting infections. In sepsis, the immune response to an infection gets out of control, causing extreme inflammation that damages healthy body tissues. Damage to the body’s organs, such as the kidneys, liver, lungs or brain, affects how these organs function and can lead to death. Sepsis can be hard to identify early as some of the symptoms are similar to common infections.

What are the signs and symptoms of sepsis?

A child with sepsis may display typical signs of an infection, including fever, cough or diarrhea, along with:

• fast heart rate (or intermittent drops in heart rate)
• fast or difficult breathing
• skin that is blotchy, pale or cool (or skin that is warm and flushed)
• excessive sleepiness
• restlessness or confusion (not knowing where they are)
• seizures
• poor feeding
• unexplained severe pain
• decreased urination
• a rash that does not fade when you press on it
• low blood pressure (this is a late sign)

Sepsis may look different in different children. If you suspect your child has sepsis, you should seek immediate medical care.

What causes sepsis?

Sepsis can be triggered by any type of infection in any part of the body. Even common infections such as pneumonia and urinary tract infections can lead to sepsis. Sepsis is caused by the interaction between the infection and the child’s immune system. The immune system overreacts to the infection, leading to inflammation throughout the body. Inflammation damages blood vessels, interferes with normal blood flow and oxygen delivery to body tissues, and affects how organs in the body function. Without immediate treatment, sepsis can lead to multi-organ failure and death.

Sepsis is most often triggered by bacterial infections, but can also be caused by viral, fungal or parasitic infections. Sometimes, the specific infection and source of sepsis is not found.

Who can develop sepsis?

Any child with an infection can develop sepsis. However, there is a higher risk for certain populations, including:

• newborns and young infants
• children with weakened immune systems, for example, due to cancer, organ transplant or immunodeficiency
• children without normally functioning spleens, for example, due to sickle cell disease
• children who have recently had surgery
• children with indwelling medical devices, such as urinary catheters or central venous lines
• children with chronic (long-term) diseases, such as gastrointestinal conditions, kidney disease or neurological impairments

Some medications, such as steroids used over a long time and other forms of chemotherapy, can also put children at higher risk for developing sepsis.

How is sepsis diagnosed?

There is not a specific test to diagnose sepsis. Health-care providers diagnose sepsis based on some of the signs and symptoms described above. If a health-care provider suspects sepsis after examining your child, they will order blood tests.

These tests can reveal if your child has an infection and if their organs, such as the liver and kidneys, are not working properly.

The health-care provider may also test samples of urine and, sometimes, spinal fluid (with a lumbar puncture or spinal tap) to check for bacteria or viruses in these places.

How is sepsis treated?

Your child will be admitted to hospital for treatment even if sepsis is only suspected, as it can take some time for test results to come back. Initial treatment for sepsis includes antibiotics, intravenous (IV) fluids and oxygen.

Sometimes children with sepsis need to be admitted to the intensive care unit (ICU) for closer monitoring and further treatment. If a child has severely low blood pressure, they may need special medications to raise it. If sepsis has caused kidney failure, a child may need dialysis. If sepsis has caused lung damage, a child may need a ventilator to help with breathing.

What can I do to prevent sepsis?

One effective way to prevent sepsis is to minimize the risk for infections.

• Make sure your child receives all recommended immunizations (including their annual influenza vaccine).
• Pay attention to careful hand washing and encourage your child to do the same.
• Clean any cuts or scrapes carefully and see your child's health-care provider if signs of infection develop (such as redness, pain or pus).

Take your child to the nearest Emergency Department or call 911 if your child has signs of infection or a fever with any of the following symptoms:

• racing heart rate
• fast or difficult breathing
• blotchy, cool or clammy skin
• excessive sleepiness
• restlessness or confusion (not knowing where they are)
• decreased urination
• unexplained severe pain
• a rash that does not fade when you press on it

Your child may show physical changes when their condition is serious or when their condition gets worse. Parents and caregivers can learn how to spot these signs in order to seek help from a health-care provider.

If your child’s illness looks different and more severe than previous illnesses they have had, be sure to ask “Could it be sepsis?”