Sepsis in Neonates and Children

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Background

A recent resolution by the United Nations World Health Assembly recognized that sepsis is a main contributor to global morbidity and mortality and requested for improved prevention, recognition, diagnosis and management of sepsis across all age groups for next decade. In addition, the WHO has recently defined the need to improve the burden of neonatal sepsis as one of the Sustainable Development Goals. The incidence of neonatal and childhood sepsis varies with geographical location and changes over time, reflecting differences in resources, maternal and infant risk factors, and prevention strategies. Sepsis represents one of the most common neonatal diseases even in high income countries. Extremely preterm infants are the most vulnerable patients, with reported rates as high as 40%. Neonates and young children are particularly susceptible to severe or lethal infections, with over three million childhood deaths annually worldwide, including over 400’000 deaths in neonates. Survivors of pediatric and neonatal sepsis are at risk of long-term sequelae, resulting in lifelong burden to patients and families.

Currently, pediatricians are challenged by recognizing community-acquired sepsis out of the vast majority of febrile children presenting to emergency departments, and by the rapidly growing group of high-risk patients at risk of hospital-acquired sepsis due to resistant pathogens in an era when effective antibiotics represent an increasingly limited resource. In preterm neonates, the majority of cases are related to nosocomial infection, a potentially preventable condition, highlighting the importance of reinforcing implementation of existing prevention strategies, and developing novel preventive interventions. The lack of specificity of clinical and laboratory signs of infection, the rapid progression to adverse outcomes if untreated, combined with the lack of sensitivity of blood cultures and traditional sepsis markers, result in a high exposure to antibiotics. Considering the failure of most past neonatal and pediatric sepsis trials to result in better outcomes, currently promoted strategies focus on delivery of early bundled care to all patients. In view of the aim to reduce the burden of pediatric sepsis on individual child health, family-centered outcomes, and the society, evaluation of bundled care is needed, with an emphasis on antimicrobial stewardship. Ultimately, improved risk stratification and defining avenues towards personalized medicine in pediatric sepsis have the potential to result in more effective treatments.

The proposed Frontiers in Pediatrics Topic is open to submissions highlighting the challenges, obstacles, and opportunities in assessing sepsis burden, understanding sepsis, and improving sepsis outcomes in neonates and children. Current challenges and controversies around neonatal and pediatric sepsis to be considered for submissions include the assessment of the global and regional burden of sepsis in high, middle and low income countries; the need for definitions of sepsis applicable to all age groups and settings; the need for an improved understanding of the immunological basis underlying the high susceptibility to infection in early life; the development and implementation of existing and novel preventive interventions and strategies for early recognition, diagnosis and discrimination of sepsis from non-infectious conditions; and monitoring and management of sepsis, including fluid resuscitation, inotropes, and immunomodulatory agents.

Keywords: Neonate, child, immune dysregulation, sepsis, mortality

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