Diagnostic criteria for sepsis in children

The most obvious symptom of childhood sepsis is fever, accompanied by chills and shortness of breath. These symptoms are the criteria for diagnosing childhood sepsis. In severe cases, organ dysfunction may also occur, such as thrombocytopenia.

(1) General condition: fever (>38.3℃) or hypothermia (<36℃); increased heart rate (>90 beats/min) or >2 standard deviations above the normal value for age; increased breathing (>30 breaths/min); altered consciousness; significant edema or positive fluid balance >20 ml/kg for more than 24 hours; hyperglycemia (blood sugar >7.7mmol/L) without a history of diabetes.

(2) Inflammatory indicators: leukocytosis (>12×109/L) or leukocytopenia (<4×109/L) or normal leukocytes but immature cells >10%; plasma C-reactive protein >2 standard deviations of normal value; plasma procalcitonin >2 standard deviations of normal value.

(3) Hemodynamic indicators: hypotension (systolic blood pressure <90 mmHg, mean arterial pressure <70 mmHg or systolic blood pressure drops by >40 mmHg in adults, or is 2 standard deviations below the normal value for age); mixed venous oxygen saturation (SvO2) >70%; cardiac index (CI) >3.5 L/min/m2.

(4) Organ dysfunction parameters: oxygenation index (PaO2/FiO2) <300; acute oliguria (urine volume <0.5 ml/kg/h); creatinine increase ≥44.2 μmol/L; abnormal coagulation function (international normalized ratio >1.5 or activated partial thromboplastin time >60s); intestinal paralysis: disappearance of bowel sounds; thrombocytopenia (<100×109/L); hyperbilirubinemia (total bilirubin >70mmol/L).

(5) Tissue perfusion parameters: hyperlactatemia (>3 mmol/L); prolonged capillary refill time or skin mottling.

It should be noted that the new diagnostic criteria do not emphasize that sepsis can only be diagnosed if the above 5 or more symptoms are present in addition to infection. Instead, it emphasizes the use of abnormal indicators combined with specific changes in the clinical condition of the clinical specialty to make a clinical diagnosis of sepsis that is more in line with clinical reality.