Septic Shock in Children

Septic shock in children means that there have been complications from an infection that "got away." "Septic" means infected. "Sepsis" is an infection that has gotten into the blood. Septic shock, then, is the series of consequences that occur when sepsis is either treated unsuccessfully or not treated. It is most common in the very young child, especially those who have weakened or immature immune systems.

Symptoms

• By the time symptoms of septic shock are present, the child affected is gravely ill. Blood pressure becomes low. It may even be so low as to be unmeasurable in some cases. The child's hands, arm, feet and legs are usually cool to touch and may even have changed color to pale, white or purple. Organs are affected, and urine output may cease. There can be mental changes such as confusion or agitation. Fever may be present, but temperature can be low as well. This is particularly true of newborns. Heart rate may be fast, and the pulse feels thready to touch. Alternately, in late septic shock, the heart rate may become irregular and slow.

Causes

• Overwhelming infection may be caused by nearly any bacterial infection. Common circumstances that predispose a child to septic shock are suppressed immune conditions such as AIDS and leukemia. Any pre-existing disease makes a child more vulnerable, especially a disease that affects an organ system, such as liver, kidney or heart disease. A child who is hospitalized for a long period of time can be at risk for infection and septic shock, especially if he has had an indwelling urinary catheter or a long-term intravenous line. These types of equipment that enter the body predispose a patient to infection since there is a direct line for bacteria from the outside to the inside. Long-term use of antibiotics may lead to a risk for sepsis once bacteria become resistant to the antibiotics.

Diagnostics and Treatment

• Any child who is or is suspected of being in septic shock will be admitted to the intensive care unit from the emergency room. No parent misses the fact that the child is seriously ill, though it can progress rather quickly. Blood tests are obtained to check for acid-base balance, organ function, oxygenation and the presence of bacteria. In the case of bacteria, it will only be to identify the organism since septic shock is easy to identify by experienced health-care personnel. Chest X-rays may be done to check for pneumonia, but it is likely that treatment will be initiated before the X-rays since the child is so seriously ill and may have organ failures. If pneumonia is present, it is less of an issue than shock and will be covered by antibiotics anyway. Antibiotics are started immediately in suspected septic shock. Other treatments depend upon symptoms and may include mechanical ventilation. Intravenous fluids and oxygen are used to support circulation. Medications may be used to increase blood pressure.

Complications

• A high percentage of children in septic shock die. Once shock has occurred, the primary infection has been able to affect organs and tissues of the body to a large degree. Those who survive may have organ dysfunction or require amputation of limbs that have been without circulation. Some children require continuous mechanical ventilation. Others suffer neurological complications such as seizures and mental changes. On the other hand, those who get early, prompt care are more likely to have a successful outcome.

Prevention

• Prevention of septic shock is not always possible. Prompt, aggressive treatment of serious infection is critical. This must be balanced with guarding against the overuse of antibiotics, however. Good infection-control practices in hospitals and good sanitation and cleanliness everywhere are our best protection.