Abstract
In the current era, pediatric sepsis remains a public health problem of significant prevalence and impact. With mortality rates practically unchanged over the years, this review hopes to briefly summarize the epidemiology and the current interventions for pediatric sepsis and point towards possible areas of improvement. Most pediatric studies of sepsis are either small, retrospective or observational. Given information technology spreading across country, and a stronger presence of clinical networks, development of multicenter prospective studies over the next decade should enable better treatments for pediatric sepsis, and improved outcomes.
Highlights
Sepsis-induced myocardial dysfunction is increasingly being recognized in pediatric sepsis [22,23,24], a standard evaluation accepted by the pediatric bedside ultrasound community has yet to be published
Strain echo may be an effective tool for early diagnosis of sepsis-induced myocardial systolic dysfunction in pediatric septic shock [25], translation of this method to routine bedside management of pediatric sepsis is not feasible, because of equipment cost and training requirements
This problem is exacerbated by malnutrition and severe anemia, which are common in many parts of the developing world, as shown by the Fluid Expansion as Supportive Therapy (FEAST) study [32]
Summary
Sepsis is a major cause of death and morbidity in the United States and throughout the world. Sepsis is the tenth leading cause of death among children in the US, with an overall mortality of 4%–10%, reaching as high as 24% for children admitted to the Pediatric Intensive Care Unit (PICU) [3]. For children with access to medical care, outcomes are similar in resource-rich continents (North America, Europe, Australia/New Zealand), compared to resource-poor parts of the world (Asia, Africa and South America) where PICU mortality is 23% versus 29% and hospital mortality is 24% versus 31% [3]. In the last few years, an increase in the prevalence of sepsis has been observed This change likely reflects an increase in sepsis surveillance, an expanding population of vulnerable children with chronic morbidities, and increasing rates of multidrug resistant organisms and opportunistic infection [3,4]
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