Paediatric sepsis: diagnosis, antimicrobial treatment and source control

Overview & Definition

A febrile child who has stopped interacting, a toddler with cold mottled limbs and a racing heart, and a neonate who will not feed are the clinical faces of paediatric sepsis. The diagnosis does not wait for microbiological proof. Sepsis is a syndrome: the child's own dysregulated response to infection has begun to injure their organs, and the team's job is to recognise that injury, reverse it, and treat the cause before it becomes irreversible. [1] [2] [12]

The 2024 Phoenix criteria redefined paediatric sepsis as suspected infection together with life-threatening organ dysfunction measured by a validated score. A child meets sepsis when the Phoenix score is two or more points, and meets septic shock when at least one of those points comes from cardiovascular dysfunction. These definitions replaced the old systemic inflammatory response syndrome (SIRS) framework because SIRS criteria had poor predictive properties and discriminated mortality badly compared with organ-dysfunction-based criteria. [1] [2] [5]

Four ideas run through this whole topic and bind it together. Recognise the syndrome early and escalate. Resuscitate the failing circulation and breathing. Treat the organism with timely, appropriate antimicrobials. Control the source by draining, debriding, or removing the infected focus. The four pillars must run in parallel, not sequence, and each is reassessed against the child's response rather than against a fixed target. [3] [10] [11]

[3] [10] [11]

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