Signs of sepsis | Health Beat


Basic lab tests are often helpful to determine if there’s higher likelihood of infection, although more targeted labs can help identify specific infections that may cause sepsis. (For Spectrum Health Beat)

In the U.S., about 75,000 children develop severe sepsis each year.

“It can affect a child or adult of any age,” said Adam Nicholson, MD, director of safety and improvement and pediatric emergency medicine physician at Spectrum Health Helen DeVos Children’s Hospital.

“It remains one of the leading causes of death in children worldwide, even with advances being made in treatments and mortality.”

But there is reassurance for parents: The chances of your child developing sepsis out of nowhere, without warning, is unlikely.

“(Sepsis) is more common in children who have a longer-range illness—immunocompromised, for instance,” Dr. Nicholson said. “This doesn’t usually come out of nowhere to affect an otherwise healthy child. It can, but is much less common.”

It’s certainly wise for parents to be aware of what sepsis is, but if a child doesn’t have an underlying health condition that makes them more vulnerable, there is typically less cause for concern.

Dr. Nicholson offered some additional insights about sepsis and talked about what parents should know.

What is sepsis?

Infection can happen when bacteria, viruses or fungi enter the body. Sepsis is a life-threatening condition that can occur when the body begins to respond strongly to that infection by attacking its own tissues.

Some sepsis symptoms include fever, lethargy and trouble urinating, but the condition can also lead to serious problems in vital organs such as the heart, lungs or kidneys.

“When we see extremely severe cases, it can lead to multisystem organ failure,” Dr. Nicholson said. “It can progress to septic shock, which may cause a dramatic drop in blood pressure that can lead to severe organ failure or death.”

Getting medical assistance via antibiotics and intravenous fluids can greatly increase the chances of survival, he said.

Bottom line: Sepsis is always the result of an infection.

“The immune system is overwhelmed and can’t maintain other vital organ function,” Dr. Nicholson said.

What are signs and symptoms?

In its early stages, sepsis can look like any other illness that causes a fever, Dr. Nicholson said.

“For the large majority of kids, it is a fever,” he said. “But that won’t be the only indicator. When we start seeing other signs of illness affecting the child, we start to think about sepsis possibly causing this.”

Some examples: the child’s skin color looks pale or unusual, or the child is unusually sleepy or lethargic. If a child is having trouble urinating, that could indicate trouble.

When a child is in the hospital, care teams can use screening tools to monitor vital signs, such as breathing, heart rate and oxygen level. This can help spot problems.

If a child has a fever, over-the-counter medication will usually help.

“With sepsis, this isn’t always the case,” Dr. Nicholson said. “A period of observation can usually give us time to decide if they have a more serious infection.”

What does treatment entail?

“When we identify there are signs of sepsis, we typically will start early with aggressive treatment,” Dr. Nicholson said.

This can include IV fluids that get into the vascular system, improving blood flow to vital organs, and antibiotics.

“In large part, sepsis is due to a bacterial infection,” he said. “When there is a sign or symptom, a course of antibiotics early on can improve outcomes.”

After that, doctors work to determine if any organs are affected. They then develop personalized treatment plans.

Can specific conditions lead to sepsis?

Patients who have a suppressed immune system or an underlying medical condition are at higher risk for sepsis.

“Very young infants, under the age of 30 days, who don’t have a fully functioning immune system can also be at risk,” Dr. Nicholson said. “And also, children who have conditions that require they have hardware in place—for example, a heart valve or central line.”

How is sepsis diagnosed?

Sepsis is diagnosed by a physical exam that includes checking heart rate and vital signs.

“We have lab markers that help us direct care,” Dr. Nicholson said. “Basic labs often are helpful to understand if there is a higher likelihood of infection going on. And more targeted labs can identify specific infections that may cause sepsis to occur.”

When should you see a doctor?

“Knowing that fevers are very common in children, I always tell parents if you are concerned about how your child is behaving with fever—lethargic, skin color is abnormal, limited urination, not eating or drinking—call your physician for guidance and observation,” Dr. Nicholson said.

For most children, a fever will respond well to over-the-counter medications such as Tylenol or ibuprofen, he said.

“The fever should go down and they will become more playful and active,” he said. “If this does not help, parents need to use their best intuition or seek care at an urgent care or emergency department.”

If a child has a fever of 102-103 degrees or higher, as well as other symptoms, parents should contact their physician for guidance.

“The large majority of these children will respond well to home care with typical over-the-counter medications,” Dr. Nicholson said.

Sharing best practices

Helen DeVos Children’s Hospital is participating in a multi-center quality improvement incentive through the Children’s Hospital Association, focusing on improving pediatric sepsis outcomes.

“The goal is for all institutions to implement best practices in terms of diagnosis and treatment to reduce mortality and hospital stays with sepsis,” Dr. Nicholson said.

Helen DeVos Children’s Hospital applies multiple initiatives to ensure early sepsis diagnosis and proactive treatment. For instance, physicians connect all patients brought in via the emergency department to an electronic sepsis screening tool that works in the background at all times.

If there are signs of sepsis, physicians are alerted.

“This sets off a chain of command where a sepsis huddle will take place on the patient’s behalf, and additional labs and treatments might be necessary,” Dr. Nicholson said.

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