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Pediatric SIRS, Sepsis, and Septic Shock Criteria

Defines the severity of sepsis and septic shock for pediatric patients.

Note: There is still debate about how to define pediatric sepsis given varying ranges of “normal” vital signs for ages. For patients over 18, please use the Adult SIRS, Sepsis, and Septic Shock Criteria.

SIRS Criteria (≥2 meets SIRS definition, 1 of which must be abnormal temperature or leukocyte count)
List of Age-Dependent Vital Sign Ranges Available in About Section

Temp >38.5°C (101.3°F) or <36°C (96.8°F)

Tachycardia or bradycardia (if <1 year)
Tachypnea or mechanical ventilation (related to an acute process)
Abnormal leukocyte count or >10% bands

Sepsis Criteria (SIRS + Source of Infection)

Suspected or present source of infection

Severe Sepsis Criteria (Sepsis + ≥1 following Dysfunction Criteria)
Organ Dysfunction Criteria »

Cardiovascular dysfunction OR ARDS OR ≥2 other organ dysfunction

Septic Shock Criteria (Sepsis + Cardiovascular Dysfunction)
Organ Dysfunction Criteria »

Cardiovascular dysfunction despite adequate fluid resuscitation

Result:

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Management
  • Much of the current practice in pediatric sepsis screening are applied from the adult literature, and therefore not directly evidence-based.
  • Similar to adults, Those with a suspected/confirmed infection with hemodynamic instability should immediately be treated for Septic Shock without waiting for laboratory confirmation.
  • Similar to adults, early IV fluids and broad-spectrum antibiotics seem to be the most critical actions.
  • IV fluid recommendations include repeated 20cc/kg boluses of isotonic crystalloid or colloid over 5-10 minute intervals.
  • Consider consulting an ICU when severe sepsis / septic shock is identified.

Pediatric Advanced Life Support (PALS) 2011 Algorithm for Septic Shock

Pediatric Advanced Life Support (PALS) 2011 Algorithm for Septic Shock
Critical Actions
  • Surviving Sepsis Campaign (2012) section on Pediatric Considerations reiterates the most recent PALS guidelines as described by Brierley and colleagues.
  • Historically pediatric sepsis management has been provider-dependent. More recently some hospitals and US states are instituting, studying, and fine-tuning standardized pediatric sepsis protocols.
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