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Clinical Update in Pediatric Sepsis: Focus on Children With Pre-Existing Heart Disease
Scott L Weiss1, Susan C Nicolson2, Maryam Y Naim2
1Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Sepsis is a severe infection causing organ dysfunction in children, particularly those with heart disease. This review covers pediatric sepsis epidemiology, management, and anesthetic considerations.
Area of Science:
- Pediatric critical care medicine
- Pediatric cardiology
- Infectious diseases
Background:
- Sepsis is a leading cause of childhood morbidity and mortality globally.
- Children with congenital or acquired heart disease face increased sepsis risk and poorer outcomes.
- Effective sepsis management involves multidisciplinary collaboration.
Purpose of the Study:
- To review the epidemiology of pediatric sepsis, focusing on children with heart disease.
- To compare pediatric and adult sepsis presentations and management.
- To discuss current hemodynamic guidelines, mechanical circulatory support, and anesthetic management for pediatric sepsis.
Main Methods:
- Literature review and synthesis of current evidence on pediatric sepsis.
- Analysis of epidemiological trends and risk factors.
- Examination of treatment guidelines and supportive care strategies.
Main Results:
- Pediatric sepsis epidemiology is evolving, with specific challenges in children with heart disease.
- Hemodynamic management strategies for septic shock in children require adaptation for cardiac patients.
- Mechanical circulatory support and specialized anesthetic care are crucial in severe cases.
Conclusions:
- Understanding the nuances of pediatric sepsis, especially in those with heart disease, is critical.
- Adherence to updated hemodynamic guidelines and consideration of advanced support are essential.
- Multidisciplinary care optimizes outcomes for children with sepsis and cardiac conditions.
Abstract:
SEPSIS REMAINS one of the most common causes of childhood morbidity, mortality, and higher healthcare costs, with over 75,000 hospital admissions in the United States and an estimated 4 million cases worldwide per year. While standardized criteria to define sepsis are in flux, the general concept of sepsis is a severe infection that results in organ dysfunction. Although sepsis can affect previously healthy children, those with certain pre-existing comorbid conditions, including congenital and acquired heart disease, are at higher risk for both developing sepsis and having a poor outcome after sepsis. Multiple specialists including intensivists, cardiologists, surgeons, and anesthesiologists commonly contribute to the management and outcome of sepsis in children. In this article, the authors examine the evolving epidemiology of pediatric sepsis, including the subset of patients with underlying heart disease; contrast pediatric and adult sepsis; review the latest hemodynamic guidelines for management of pediatric septic shock and their application to children with heart disease; discuss the role of mechanical circulatory support; and review key aspects of anesthetic management for children with sepsis.
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