Sepsis in Children

Abstract

Sepsis is systemic inflammatory response syndrome due to a documented or suspected infection. Causative agents of sepsis include group B streptococcus, Escherichia coli, and Listeria monocytogenes in infants younger than 2 months, and communityacquired organisms. Bacteremia may ensue in patients whose defense mechanisms have become vulnerable due to many factors. Sepsis and septic shock can be viewed as clinical pictures, which develop as consequences of proinflammatory processes/ cytokines leading to a state that cannot be restrained by anti-inflammatory processes/ cytokines. As yet, a cytokine, which is uniquely associated with severe sepsis and septic shock and can be used as a biomarker, has not been discovered. Sepsis is a cytokine storm, which may adversely affect almost any organ system. Whether there is an association between the severity of sepsis or septic shock and cytokine gene polymorphisms is an important field of study. Mottled skin and prolongation of capillary refill time may help the physician recognize septic shock before hypotension emerges. The management of severe sepsis and septic shock involves (1) the hemodynamic support, (2) inotropes, vasopressors, and vasodilators, (3) antimicrobial therapy, (4) transfusions, and (5) corticosteroids as indicated. Hospital mortality of pediatric sepsis is 2-10%.

Pediatría General Tomo 13

“…La sepsis y el shock séptico se desarrollan como consecuencias de procesos proinflamatorios por citocinas que conducen a un estado que no puede ser restringido por procesos antiinflamatorios (12). Las citocinas juegan un papel principal, pues estos mediadores, que se liberan crean una enorme cascada de mediadores que posterior estimulan la producción del factor de necrosis tumoral (TNF, factor de necrosis tumoral), por estimuladores como lipopolisacárido, C5a, virus y enterotoxinas.…”