What to Know about Pediatric Sepsis

How can a small cut on a child’s arm lead to a life-threatening reaction that results in his death? One answer, unfortunately, is when a case of sepsis goes undiagnosed. This happened to 12-year-old Rory Staunton of New York City, who died five days after falling and getting a cut on his arm in his school gym. 

Rhode Island Sepsis Regulations

His legacy helps prevent cases like his from occurring with “Rory’s Regulations,” a set of New York state regulations that doctors and hospitals must follow, in addition to those already established, for treating sepsis. Since then, other states have enacted similar protocols.

In Rhode Island, Lee A. Polikoff, MD, a pediatric intensivist with Hasbro Children’s Hospital, worked with families of children who died from sepsis to advocate for similar protocols. Their efforts, which took more than five years of testifying and negotiating with Rhode Island legislature, led to the passing of a bill that established best practices for the treatment of patients with sepsis and septic shock.

At Hasbro Children’s Hospital, our doctors, nurses, and members of a child’s care team are trained to recognize and treat sepsis in pediatric patients. We are part of the national collaborative, Improving Pediatric Sepsis Outcomes (IPSO), that aims to reduce sepsis-attributable mortality and improve survivor outcomes through early identification and timely treatment. Learn more about IPSO at childrenshospitals.org.

What Is Sepsis

Sepsis is a life-threatening medical condition cause by the body’s extreme reaction to an unwanted infection. Additional facts about sepsis:

• The body attacks its own organs and tissues, which can lead to tissue damage, organ failure, and death. 
• However, sepsis can be treated with antibiotics and fluids if diagnoses early. 
• More than 1.7 million people in the United States develop sepsis every year; at least 350,000 of them die.
• Globally, 11 million people die from sepsis each year.
• Rapid diagnosis and treatment can prevent up to 80 percent of fatalities.
• It is the most expensive condition treated in US hospitals.
• Sepsis is a major challenge in hospitals, where it’s one of the leading causes of death. It's also a main reason why people are readmitted to the hospital. Sepsis occurs unpredictably and can progress rapidly.

Causes of Sepsis

Sepsis can be triggered by different kinds of germs, including bacteria (E. coli), viruses (influenza or flu), and fungi (candida), but is most often triggered when bacteria get into the blood, lungs, kidneys, or abdomen or break through normal barriers, like a cut in the skin.

Children with sepsis are often critically ill, usually requiring emergency treatment and admission to a pediatric or neonatal intensive care unit. 

What Are the Symptoms of Sepsis in Children?

Unlike most adults, with sepsis, the presentation of sepsis in children appears on a spectrum, with the early signs and symptoms overlapping routine childhood illnesses:

• Symptoms may be as subtle as fever, lethargy, nausea, and dizziness
• Rash, particularly bright red and warm areas, or small reddish-purplish bumps that do not blanch or disappear when you pushed upon
• Less urine output than normal

Pediatric sepsis is a medical emergency and survival is linked to timely treatment with targeted antibiotics, isotonic fluids, vasopressors, and aggressive supportive care.

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. A child with a weakened immune system can be especially susceptible to sepsis.

Startling Statistics about Pediatric Sepsis

Additional facts about sepsis in infants and children:

• In the US, more than 75,000 children develop severe sepsis each year. Almost 7,000 of these children die.
• Many children who survive sepsis are left with long-term problems. More than one in three children who survive experience a change in cognitive skills still at 28 days following their discharge from the hospital. Nearly half return to the hospital at least once after surviving sepsis.
• Sepsis can occur from infections that occur as a result of unsanitary conditions at birth, infections during pregnancy that are passed on to the newborns, or preventable infections that may be more prevalent in countries with limited vaccinations and medical care.
• As with an adult, a child can develop sepsis as the result of any type of infection.
• Preterm infants who are Black are more than twice as likely to develop sepsis and are more likely to die than non-Black infants.
• Children with severe sepsis or septic shock who are Black or Hispanic are more likely to die than non-Hispanic White children.

What to Do If You Suspect Sepsis

Sepsis needs to be suspected and recognized as quickly as possible. The risk of death increases for every hour of delayed treatment. If you suspect sepsis, seek medical attention immediately.

If you suspect or recognize sepsis in child under your care, contact the Hasbro Children's Emergency Department, at 401-444-4900 to speak with the referral nurse or a pediatric emergency medicine physician.

Learn more about pediatric emergency services at Hasbro Children's Hospital

Sources for this story include the Sepsis Alliance, CDC, Children’s Hospital of Philadelphia, Children’s Hospital Association, Mayo Clinic, Yale Medicine, National Public Radio, RI.Gov, USA Today.