Abstract
Pediatric Sepsis: Early Recognition, Risk Stratification, and Evidence-Based Management
Pediatric sepsis remains a time-dependent emergency with substantial mortality, morbidity and long-term functional consequences. Its early diagnosis is difficult because the first manifestations in children often overlap with common febrile illnesses, while hypotension may appear only after compensatory mechanisms have begun to fail. This narrative review discusses current evidence on early recognition, risk stratification and initial management of pediatric sepsis and septic shock, with emphasis on emergency departments, pediatric wards and pediatric intensive care units. The review addresses the transition from systemic inflammatory response syndrome-based concepts to organ dysfunction-centered definitions, including the Phoenix criteria and the Phoenix Sepsis Score. It also summarizes the clinical utility and limitations of pediatric severity scores, including the Pediatric Sequential Organ Failure Assessment score, Pediatric Logistic Organ Dysfunction-2, quick Pediatric Logistic Organ Dysfunction-2 and biomarker-based models such as the Pediatric Sepsis Biomarker Risk Model. From a therapeutic perspective, the main principles are rapid clinical recognition, prompt antimicrobials when septic shock is suspected, individualized fluid resuscitation with frequent reassessment, early vasoactive support when shock persists, source control when feasible and continuous monitoring of perfusion, respiratory status, renal function, fluid balance and organ dysfunction. Current evidence supports structured sepsis pathways and bundled care, but important controversies remain regarding universal screening tools, optimal fluid volume and type, vasoactive selection, lactate thresholds and the best strategy to balance early antimicrobial therapy with stewardship. Therefore, pediatric sepsis care should combine validated definitions, bedside clinical judgment, institutional protocols and serial reassessment rather than relying on any single score, biomarker, or alert system.
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