Chapter 8
SEPSIS
Ana Ruzic, MD
Samir Gadepalli, MD
Ronald Hirschl, MD(^)
I. Introduction and Basic Considerations
Sepsis remains a frequent cause of pediatric morbidity and mortality,
despite significant advances in diagnosis and management of pediatric
infections.^ While the outcomes are improving in the United States, the incidence
of sepsis continues to rise, making it one of the most common admission
diagnoses in the pediatric and neonatal ICUs. [1-6]^ Early recognition and
initiation of goal-directed therapy remains the mainstay of care, whether caring
for neonates or young children. In addition, timely source control, through
appropriate antimicrobials and/or surgical intervention, is crucial in assuring
recovery and best outcomes.
The principles of therapy, which have been applied in the adult population,
carry over well into the management of pediatric sepsis, although modifications
need to be made based on the child’s age and comorbidities. Neonates, in
particular, represent a challenging population, as their source of sepsis varies,
depending on the gestational age, congenital anomalies, and circumstances
surrounding their delivery.[5]^ It should be stressed that regardless of the source,
once sepsis is suspected, supportive care should not be delayed until