Diagnosing Sepsis in Children

Experts at Hassenfeld Children’s Hospital at NYU Langone are experienced in identifying the early signs of sepsis, a life-threatening inflammatory response to infection.

Normally, the body’s immune system responds to an infection by unleashing a cascade of chemical signals to kill bacteria, viruses, or fungi. Sometimes, however, these signals may go into overdrive, causing the body to attack its own organs and tissues.

Sepsis can have life-threatening consequences, such as organ failure and septic shock, which can occur as the body works harder to maintain blood pressure and deliver nutrients to organs.

There are two types of septic shock. In compensated shock, the heart works harder to maintain blood pressure but cannot deliver enough oxygen and nutrients to vital organs. In uncompensated shock, the heart is unable to maintain blood pressure or deliver oxygen and nutrients to the body.

Risk Factors

Any type of infection can lead to sepsis in an infant or a child with a weakened immune system, especially if he or she is being treated in the hospital for a serious illness, such as cancer. Certain bacterial infections, such as methicillin-resistant Staphylococcus aureus, or staph infection—an infection that is resistant to treatment with ordinary antibiotics and may be acquired in a hospital or other places where many people are in close contact—are more likely to trigger sepsis.

Having an indwelling catheter—a flexible tube that is inserted into the body to deliver medications and nutrition or to drain urine or other fluids—also increases the risk of infection and sepsis.

The risk of sepsis is higher in babies who are born prematurely—before week 37 of pregnancy—or are less than a month old. Infection with the bacteria group B Streptococcus during pregnancy and premature rupture of the amniotic sac—the fluid-filled bag in which the baby grows and develops in the womb—also increase the risk of sepsis.

Symptoms of Sepsis

Sepsis can be difficult to distinguish from an ordinary infection, especially in very young babies. Babies and children with sepsis may have a fever or a lower-than-normal temperature. A normal temperature is approximately 97.6° to 100.5° F or 36.5° to 38° C. The skin of a child with sepsis can feel very cool or very warm to the touch. Other symptoms may include listlessness, irritability, a decrease in urination, and difficulty breathing or eating.

Our pediatricians have developed a computerized alert system to help doctors and nurses rapidly identify signs of sepsis—including sudden changes in temperature, heart rate, or respiratory rate—in babies and children who are being treated in the hospital. The warning system alerts doctors to begin a physical exam immediately.

Confirming a Diagnosis of Sepsis

A variety of evaluations and tests may be performed to confirm a diagnosis of sepsis in a child, including:

Physical Exam

During a physical exam, a doctor uses a thermometer to measure your child’s temperature. The doctor also measures the child’s respiratory and heart rates to determine if the lungs and heart are working harder than normal.

Laboratory Tests

Several laboratory tests may be performed to identify the cause of an infection and to look for specific biochemical markers, or signs, of infection or sepsis. Blood tests measure the total number of blood cells, including infection-fighting white blood cells and oxygen-carrying red blood cells. Blood tests also measure the amount of the hormone procalcitonin and C-reactive protein, which often increase when a child has a bacterial infection, and substances such as creatinine and blood urea nitrogen, which can indicate kidney problems.

If your child has signs of a kidney, bladder, or urinary tract infection, the doctor may look for the presence of bacteria in a urine sample. The doctor may also examine a sample of fluids or mucus taken from medical tubes that have been placed in the body to deliver oxygen, medications, or nutrition to children who are being treated in the hospital.

Chest X-ray

A chest X-ray may be performed to look for pulmonary edema, a buildup of fluid in the lungs. Pulmonary edema may reveal that your child has a respiratory infection, such as pneumonia, and can also be a sign that the heart is not working well.

Peripheral Pulse Oximetry

A peripheral pulse oximeter is a device that is used to measure oxygen levels. The device consists of a small sensor that is placed on your child’s fingertip with a painless clip. The sensor uses the light-absorbing properties of hemoglobin—a substance in the blood that contains oxygen, which gives blood a red color—and the child’s pulse to measure how much oxygen is in the blood.

Information from these tests can help to determine the severity of your child’s condition and the type of treatment that may be most effective.