Abstract
The inflammatory response in pediatric sepsis is highly dynamic and includes both pro- and anti-inflammatory elements that involve the innate and adaptive immune systems. While the pro-inflammatory response is responsible for the initial clinical signs and symptoms of sepsis, a concurrent compensatory anti-inflammatory response often results in an occult, but highly clinically relevant, form of acquired immunodeficiency. When severe, this is termed “immunoparalysis” and is associated with increased risks for nosocomial infection, prolonged organ dysfunction, and death. This review focuses on the pathophysiology and clinical implications of both over- and under-active immune function in septic children. Host-, disease-, and treatment-specific risk factors for immunoparalysis are reviewed along with immune phenotype-specific approaches for immunomodulation in pediatric sepsis which are currently the subject of clinical trials.
Highlights
Sepsis represents a dysregulated host response to infection that, when severe, results in organ dysfunction
The pathophysiology of the immune response in sepsis is an attractive target for the development of novel treatments to improve outcomes in critically ill children with sepsis
Sepsis is triggered by an initial infectious insult, much of the damage done to the host is not directly due to the pathogen but to the dysregulated host inflammatory response that can persist even after the initial infection has been controlled
Summary
Sepsis represents a dysregulated host response to infection that, when severe, results in organ dysfunction. While the timely recognition of sepsis and provision of fluid resuscitation and antibiotics have resulted in improvements in sepsis outcomes over the last two decades [3,4], over 7000 children still die of sepsis every year in the United States alone [5]. The pathophysiology of the immune response in sepsis is an attractive target for the development of novel treatments to improve outcomes in critically ill children with sepsis. We know that the immune response in sepsis is highly dynamic, with many children demonstrating a compensatory anti-inflammatory response that represents a clinically important, occult form of acquired immune deficiency. Understanding the variability of the immune response in children with sepsis will allow the development of new, personalized approaches to sepsis treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
