Sepsis In Children brief overview to students .pptx

Sepsis in children overview

1. Sepsis in Children Dr. Sarthak Naik Assistant Professor Pediatrics SCB & SVPPGIP, Cuttack

2. Outline Understanding Sepsis in Pediatric Patients Clinical Presentation & Diagnosis Management Guidelines Outcome & Future Directions Prevention / Awareness

3. Overview Sepsis is a Clinical syndrome caused by a dysregulated host response to severe infection Major public health problem and an important cause of morbidity and mortality In chidren , sepsis can present atypically,making early recognition crucial,necessitating prompt intervention

4. Epidemiology Chidhood sepsis: 1.2 Million cases per year. More than 4% of all hospitalised patients less than 18 years of age. Admitted to PICU: 8% (western); 40-67% (India) Mortality ranges from 4% to 50% (illness severity,risk factors,geographical locations) Majority death: Refractory shock, MODS Greater than 50% of sepsis fatalities occur within 24 hours and half of these patients die before transfer to Pediatric Intensive Care Unit (PICU) care

5. International Consensus Definition of Pediatric Sepsis

6. International Consensus Definition of Pediatric Sepsis Infection SIRS Sepsis Severe sepsis Septic Shock MODS

7. Infectious agent In the Blood Localized Sepsis

8. Etiology DEPENDS ON AGE COMMUNITY/Hospital acquired site presence of immunodeficiency

9. Risk factors for sepsis/septic shock Age (prematurity, newborns, <1year old) Primary and acquired immunodeficiencies Neutropenia Underlying co-morbid conditions Medical devices

10. Clinical Findings Tachycardia Tachypnea Abnormal pulse (diminished, weak, or bounding) Abnormal capillary refill (central refill ≥3 seconds or flash refill [<1 second]) Altered mental status Purpura or petechiae in the body Hypotension

11. Sepsis in Newborn

12. Sign & Symptoms of Infection EOS or LOS Sepsis Screen Components Abnormal values Absolute neutrophil count Low counts as per Manroe chart for term & Mouzinho’s chart for VLBW infants Immature/Total neutrophil >0.2 Micro ESR >15 mm in 1 st hour CRP >1 mg/dl

13. Lab Diagnosis Complete Blood Count (CBC) Analysis Blood Cutures & Biomarkers Imaging Technique for infection Source

14. Management Strategies of Sepsis & Septic shock

15. Initial resuscitation Martin K, Weiss SL. Initial resuscitation and management of pediatric septic shock.  Minerva Pediatr . 2015;67(2):141-58. Focuses on: Rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function Eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications Supportive care of organ system dysfunction

16. Resuscitation bundle American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock Obtain vascular(IV/IO) access Collect blood cultures. Start broad spectrum antibiotics Measure blood lactate. Start appropriate fluid therapy Start vasoactive drugs if shock persists

17. Fluid resuscitation Up to 40–60 mL/kg in bolus fluid (10–20 mL/kg per bolus) over the first hour, titrated to clinical markers of cardiac output and discontinued if signs of fluid overload develop ICU facility available ICU facility not available and no hypotension ICU facility not available and hypotension is present No bolus fluid administration while starting maintenance fluids Up to 40 mL/kg in bolus fluid (10–20 mL/kg per bolus) over the first hour with titration to clinical markers of cardiac output and discontinued if signs of fluid overload develop

18. Antibiotic Therapy Empirical antibiotic therapy within 1hour of recognition of septic shock In sepsis associated organ dysfunction but without shock, start antimicrobial therapy as soon as possible after appropriate evaluation within 3 hrs of recognition Samples for cultures should be taken prior to antibiotic administration where possible. If no pathogen is identified on blood culture, de-escalate based on daily assessment-clinical and laboratory, narrow or stop empiric antimicrobial according to clinical presentation, site of infection, host risk factors and adequacy of clinical improvement.

19. Steroids ???? Lacks definitive evidence and consensus : still controversial. Surviving sepsis campaign guidelines : hydrocortisone should be considered for a catecholamine-resistant septic shock with suspected or proven adrenal insufficiency. RESOLVE study : no obvious hemodynamic benefit or difference in outcomes with the administration of steroids in pediatric septic shock.

20. Advanced Therapeutic Options Immunomodulatory Therapies Extracorporeal Support Techniques Target Antimicrobial Stewardship

21. Monitoring & Follow-Up Care Importance of Continuous Monitoring Long Term Follow Up Needs Multidisciplinary Approach

22. Research Trends & Innovations in Treatment Novel Therapeutic Approaches Biomarker development Advancements in Technology

23. Prevention Strategies & Public Health Implications Vaccinations Programs Public Awareness Campaigns Infection Control Practices

24. Summary Fluid resuscitation followed by vasoactive medication is the cornerstone of management of pediatric septic shock. Early recognition of septic shock and prompt intervention is key to reduction of mortality. Continuous monitoring of clinical parameters guides management. Use RRT to prevent or treat fluid overload in children who are unresponsive to fluid restriction and diuretic therapy

25. Thank you

26. References Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2020 http://www.survivingsepsis.org/Guidelines/Pages/default.aspx Miranda M, Nadel S. Pediatric Sepsis: a Summary of Current Definitions and Management Recommendations. Curr Pediatr Rep. 2023;11(2):29-39. doi : 10.1007/s40124-023-00286-3. Epub 2023 May 9. PMID: 37252329; PMCID: PMC10169116. Nelson Textbook of Pediatrics Manual of pediatric emergencies & critical care - Suchitra Ranjith ( 2 nd ed. )