Sepsis bei Kindern – alles anders?

Abstract

Background: A child with sepsis represents a great challenge for all healthcare workers involved in the rescue services and the emergency room, especially those not regularly confronted by pediatric emergencies. Method: Narrative review focused on diagnosis, epidemiology and management of neonatal and pediatric sepsis in the emergency department. Articles published in English or German within the last 5 years were eligible. Presentation of age-specific case vignettes and tables including clinical signs, risk factors, and management in the first hour during transport and in the emergency department. Results: The highest incidence of bacterial sepsis in children is reported within the first few years of life. Clinical signs, site of infection and management of sepsis are age specific. The most frequently reported organ dysfunctions in pediatric sepsis are respiratory dysfunction and circulatory depression but arterial hypotension is a late sign of circulatory insufficiency. Vasoconstriction with a cold periphery and tachycardia is typical in infants but the recognition is often not simple. Immediate administration of 20 ml/kg body weight of balanced crystalloid fluid is mandatory in a state of shock. Diagnosis of sepsis remains challenging, yet outcomes are directly related to time to recognition and treatment. Initially, laboratory markers may be normal or slightly abnormal and are thus not sufficiently predictive to rule out sepsis. Early empiric antibiotic treatment is mandatory for every clinically suspected case of pediatric sepsis. Every child with suspected sepsis has to be admitted to a children’s hospital as soon as possible. Conclusion: The early recognition of signs of sepsis, the prompt initiation of fluid replacement and an adequate antibiotic therapy remain the most important factors to improve the prognosis of pediatric sepsis.