Sepsis and septic shock: Early recognition and multipronged approach to management paramount in children

Sepsis and septic shock present serious risk to neonates and children, with high rates of mortality. Empiric antimicrobiol therapy should be instituted as soon as cultures have been obtained, prior to sensitivity results being available. Selection of initial regimens will vary depending on patient age, focus of infection and underlying disease. In addition to treating the infection, it is critical that early and aggressive multipronged supportive care is implemented. Circulatory support, primarily to maintain intravascular volume and electrolyte balance, is essential, as is early and aggresive ventilatory support. Maintenance of renal function, nutritional support and replacement of specific clotting factors is also important. Immunomodulatory therapies offer theoretical potential, but this is yet to be fully realised. Pentoxifylline is one agent shown to reduce mortality in premature infants, while endotoxin-binding proteins have also demonstrated early promise.