How to Recognize Septic Shock in Sick Children

Septic shock is a dangerous, potentially lethal condition in children. Shock occurs when a seriously ill child progresses to a point in which the body can no longer supply adequate oxygen and nutrients to essential tissues. Septic shock is a form of distributive shock and is usually the result of severe infection.

Infectious organisms that can cause septic shock in children include bacteria, viruses and fungi. The organisms themselves or toxins released from the organisms activate the child's immune system and cause an inflammatory cascade. In an ill child the immune cells and inflammatory chemicals can cause rampant cellular damage and destruction, quickly moving the child from a systemic inflammatory response in the early stages, to actual sepsis and then to full blown septic shock.

A serious infection in a child may initially cause a condition known as systemic inflammatory response syndrome (SIRS). This syndrome is characterized by an abnormally low or high temperature, a fast heart rate (or unexplained slow heart rate in children less than 1 year old), a fast respiratory rate, and a white blood cell count that is elevated or unexplainably low for the child's age or else a white blood cell count that contains greater than 10% immature neutrophils.

An infected child may then progress to sepsis, which is simply SIRS that is known to result from the presence of an infectious organism. Once a child enters sepsis they may progress to severe sepsis in which they begin to experience organ dysfunction or acute respiratory distress syndrome. Eventually, the child may progress to a state of septic shock.

Septic shock in a child is defined as the condition of sepsis (SIRS occurring with a known infection) plus cardiovascular dysfunction that persists despite the administration of large IV fluid boluses in the course of 1 hour.

The cardiovascular dysfunction that occurs in a child in septic shock is recognizable when one or more of three potential events occurs:

*Hypotension- In children, hypotension (low blood pressure) is defined as systolic blood pressure less than the 5th percentile for age

*Vasoactive drug requirement- A child who can sustain a normal blood pressure only with the use of vasoactive drugs such as norepinephrine, vasopressin or epinephrine

*At least two signs of inadequate organ perfusion which may include:

-Metabolic acidosis

-High lactate on arterial blood gas

-Oliguria (low urine output, less than 0.5 ml/kg/hr in children)

-Prolonged capillary refill time

-Difference of greater than 3 degrees Centigrade between the temperature of the child's extremities and their core temperature

The ability to recognize SIRS in children is important in potentially preventing the progression to septic shock. Health care providers and concerned parents should be aware that a child who is fighting an infection may develop a systemic response that can result in these serious, potentially lethal consequences.

Source: Pediatric Advanced Life Support. American Heart Association. 2006.