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Sepsis-Related Problems in Pediatric Patients

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Sepsis

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 18))

Abstract

The physiologic changes that constitute the process of sepsis are induced by microbial agents during bloodstream infection or by the toxic products of pathogens that are released from sites of focal infection. This process involves changes generated by the immune system and controlled by hormones, cytokines and enzymes. There are many host and microbial factors that may unfavorably influence this complex immune response. Underlying diseases with immunosuppressive effects, surgery, state of nutrition, immunomodulatory therapy and site of infection increase the risk for development of invasive disease and determine the extent of the immune response [1–3]. However, sepsis in the pediatric population occurs very frequently in previously healthy children. Also, in comparison with adults, the sepsis is more overwhelming. Mortality is mainly confined to the first 48 h of the disease. In children vs adults, different pathogens are involved and the quality and quantity of the immune response depend on the age of the child. These differences are probably caused by developmental aspects of several organ systems and may have special consequences for management and therapy.

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References

  1. Jafari HS, McCracken GHJ (1992) Sepsis and septic shock: a review for clinicians. Pediatr Infect Dis J 11(9):739–748

    Article  PubMed  CAS  Google Scholar 

  2. Bell LM, Baker MD, Beatty D, Taylor L (1992) Infections in severely traumatized children. J Pediatr Surg 27(11): 1394–1398

    Article  PubMed  CAS  Google Scholar 

  3. Ashkenazi S, Leibovici L, Samra Z, Konisberger H, Drucker M (1992) Risk factors for mortality due to bacteremia and fungemia in childhood. Clin Infect Dis 14(4): 949–951

    Article  PubMed  CAS  Google Scholar 

  4. Ferrieri P (1990) Neonatal susceptibility and immunity to major bacterial pathogens. Rev Infect Dis 12[Suppl 4]:S394–S400

    Article  PubMed  Google Scholar 

  5. Zangwill KM, Schuchat A, Wenger JD (1992) Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR CDC Surveill Summ 41(6): 25–32

    PubMed  CAS  Google Scholar 

  6. Jacobs RF, Sowell MK, Moss MM, Fiser DH (1990) Septic shock in children: bacterial etiologies and temporal relationships. Pediatr Infect Dis J 9(3): 196–200

    Article  PubMed  CAS  Google Scholar 

  7. Pryor RW, Hinshaw LB (1989) Sepsis/septic shock in adults and children. Pathol Immunopathol Res 8(5–6): 222–230

    Article  PubMed  CAS  Google Scholar 

  8. Brandtzaeg P, Kierulf P, Gaustad P, Skulberg A, Bruun JN, Halvorsen S, Sorensen E (1989) Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 159(2): 195–204

    Article  PubMed  CAS  Google Scholar 

  9. Bayston K, Cohen J (1990) Bacterial endotoxin and current concepts in the diagnosis and treatment of endotoxaemia. J Med Microbiol 31:73–83

    Article  PubMed  CAS  Google Scholar 

  10. Chesney P, Chesney R (1989) Hemorrhagic shock and encephalopathy: reflections about a new devastating disorder that affects normal children. J Pediatr 114(2): 254–256

    Article  PubMed  CAS  Google Scholar 

  11. Hellerqvist C, Sundell H, Gettins P (1987) Molecular basis for group B beta-hemolytic streptococcal disease. Proc Natl Acad Sci USA 84:51

    Article  PubMed  CAS  Google Scholar 

  12. Verheul AF, van Gaans JA, Wiertz EJ, Snippe H, Verhoef J, Poolman JT (1993) Meningococcal lipopolysaccharide (LPS)-derived oligosaccharide-protein conjugates evoke outer membrane protein but not LPS-specific bactericidal antibodies in mice: influence of adjuvants. Infect Immun 61(1): 187–196

    PubMed  CAS  Google Scholar 

  13. Baldwin G, Alpert G, Caputo GL et al (1991) Effect of polymyxin B on experimental shock from meningococcal and Escherichia coli endotoxins. J Infect Dis 164(3): 542–549

    Article  PubMed  CAS  Google Scholar 

  14. Verheul A, Snippe H, Poolman J (1993) Meningococcal lipopolysaccharides: virulence factor and potential vaccine component. Microbiol Rev 57(1): 34–49

    PubMed  CAS  Google Scholar 

  15. Poolman JT (1988) Meningococcal vaccines. J Med Microbiol 26(3): 170–172

    PubMed  CAS  Google Scholar 

  16. Cairo MS (1989) Neonatal neutrophil host defense. Prospects for immunologic enhancement during neonatal sepsis. Am J Dis Child 143(1): 40–46

    PubMed  CAS  Google Scholar 

  17. English BK, Burchett SK, English JD, Ammann AJ, Wara DW, Wilson CB (1988) Production of lymphotoxin and tumor necrosis factor by human neonatal mononuclear cells. Pediatr Res 24(6): 717–722

    Article  PubMed  CAS  Google Scholar 

  18. Cairo M (1991) Cytokines: a new Immunotherapy. Clin Perinatol 18(2): 343–359

    PubMed  CAS  Google Scholar 

  19. Wei C, Gilliam M, Cohen M, Cornell J, Moazam F (1987) A preliminary study of age-related difference in resistance to sepsis in the rat model. J Surg Res 43:460–467

    Article  PubMed  CAS  Google Scholar 

  20. Zamir O, Hasseigren PO, Frederick JA, Fischer JE (1992) Is the metabolic response to sepsis in skeletal muscle different in infants and adults? An experimental study in rats. J Pediatr Surg 27(11): 1399–1403

    Article  PubMed  CAS  Google Scholar 

  21. Pedersen PV, Warner BW, Bjornson HS et al (1989) Hemodynamic and metabolic alterations during experimental sepsis in young and adult rats. Surg Gynecol Obstet 168(2): 148–156

    PubMed  CAS  Google Scholar 

  22. Fitzgerald MJ, Goto M, Myers TF, Zeller WP (1992) Early metabolic effects of sepsis in the preterm infant: lactic acidosis and increased glucose requirement. J Pediatr 121(6): 951–955

    Article  PubMed  CAS  Google Scholar 

  23. Zeller WP, Goto M, Hurley RM (1988) Endotoxin in newborn septic shock: significance, metabolic, and cardiovascular changes. Ann Clin Lab Sci 18(3): 253–259

    PubMed  CAS  Google Scholar 

  24. Horton JW, Coln D (1985) Cardiovascular function and fluid compartments in newborn canine hemorrhagic shock. Am J Physiol 248(6, 2):R724–R731

    PubMed  CAS  Google Scholar 

  25. Agata Y, Hiraishi S, Oguchi K et al (1991) Changes in left ventricular output from fetal to early neonatal life (see comments). J Pediatr 119(3): 441–445

    Article  PubMed  CAS  Google Scholar 

  26. Fiser DH, Fewell JE, Hill DE, Brown AL (1988) Cardiovascular and renal effects of dopamine and dobutamine in healthy, conscious piglets. Crit Care Med 16(4): 340–345

    Article  PubMed  CAS  Google Scholar 

  27. Shavit G, Sagy M, Nadler E, Vidne BA, Gitter S (1989) Myocardial response to alpha-agonist (phenylephrine) in relation to age. Crit Care Med 17(12): 1324–1327

    PubMed  CAS  Google Scholar 

  28. Monsalve F, Rucabado L, Salvador A, Bonastre J, Cuñat J, Ruano M (1984) Myocardial depression in septic shock caused by meningococcal infection. Crit Care Med 12(12): 1021–1023

    Article  PubMed  CAS  Google Scholar 

  29. Boucek MM, Boerth RC, Artman M, Graham TP, Boucek RJ (1984) Myocardial dysfunction in children with acute meningococcemia. J Pediatr 105:538–542

    Article  PubMed  CAS  Google Scholar 

  30. Mercier J-C, Beaufils F, Hartmann J-F, Azéma D (1988) Hemodynamic patterns of meningococcal shock in children. Crit Care Med 16(1): 27–33

    Article  PubMed  CAS  Google Scholar 

  31. Carcillo JA, Davis AL, Zaritsky A (1991) Role of early fluid resuscitation in pediatric septic shock. JAMA 266(9): 1242–1245

    Article  PubMed  CAS  Google Scholar 

  32. Carcillo JA, Pollack MM, Ruttimann UE, Fields AI (1989) Sequential physiologic interactions in pediatric cardiogenic and septic shock. Crit Care Med 17(1): 12–16

    Article  PubMed  CAS  Google Scholar 

  33. van Teunenbroek A, Peters M, Sturk A, Borm JJ, Breederveld C (1990) Protein C activity and antigen levels in childhood. Eur J Pediatr 149(11): 774–778

    Article  PubMed  Google Scholar 

  34. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, Powers P (1987) Development of the human coagulation system in the full-term infant. Blood 70(1): 165–172

    PubMed  CAS  Google Scholar 

  35. Leclerc F, Hazelzet J, Jude B, Hofhuis W, Hue V, Martinot A, van der Voort E (1992) Protein C and S deficiency in severe infectious purpura of children: a collaborative study of 40 cases. Intensive Care Med 18(4): 202–205

    Article  PubMed  CAS  Google Scholar 

  36. Taylor FBJ, Chang A, Esmon CT, D’Angelo A, Vigano-D’Angelo S, Blick KE (1987) Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest 79(3): 918–925

    Article  PubMed  CAS  Google Scholar 

  37. Busund R, Lindsetmo R, Balteskard L, Rekvig O, Revhaug A (1993) Repeated plasma therapy induces fatal shock in experimental septicemia. Circ Shock 40:268–275

    PubMed  CAS  Google Scholar 

  38. Heyderman RS, Klein NJ, Shennan GI, Levin M (1991) Deficiency of prostacyclin production in meningococcal shock. Arch Dis Child 66(11): 1296–1299

    Article  PubMed  CAS  Google Scholar 

  39. Gill AB, Weindling AM (1993) Echocardiographic assessment of cardiac function in shocked very low birthweight infants. Arch Dis Child 68[Suppl 1]: 17–21

    Article  PubMed  CAS  Google Scholar 

  40. Waage A, Halstensen A, Shalaby R, Brandtzaeg P, Kierulf P, Espevik T (1989) Local production of tumor necrosis factor alpha, interleukin 1, and interleukin 6 in meningococcal meningitis. Relation to the inflammatory response. J Exp Med 170(6): 1859–1867

    Article  PubMed  CAS  Google Scholar 

  41. Waage A, Brandtzaeg P, Halstensen A, Kierulf P, Espevik T (1989) The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med 169(1): 333–338

    Article  PubMed  CAS  Google Scholar 

  42. Saladino R, Erikson M, Levy N, Bachman D, Silber GR, Fleisher GR (1992) Utility of serum interleukin-6 for diagnosis of invasive bacterial disease in children. Ann Emerg Med 21(12): 1413–1417

    Article  PubMed  CAS  Google Scholar 

  43. Sullivan JS, Kilpatrick L, Costarino ATJ, Lee SC, Harris MC (1992) Correlation of plasma cytokine elevations with mortality rate in children with sepsis. J Pediatr 120(4,1): 510–515

    PubMed  CAS  Google Scholar 

  44. Hazelzet JA, van den Voort E, Lindemans J, ter Heerdt PGJ, Neyens HJ (1993) Relation between cytokines and routine laboratory parameters in children with septic shock and purpurae. Intensive Care Med (in press)

    Google Scholar 

  45. Halstensen A, Ceska M, Brandtzaeg P, Redl H, Naess A, Waage A (1993) Interleukin-8 in serum and cerebrospinal fluid from patients with meningococcal disease. J Infect Dis 167(2): 471–475

    Article  PubMed  CAS  Google Scholar 

  46. Brandtzaeg P, Joo GB, Brusletto B, Kierulf P (1990) Plasminogen activator inhibitor 1 and 2, alpha-2-antiplasmin, plasminogen, and endotoxin levels in systemic meningococcal disease. Thromb Res 57(2): 271–278

    Article  PubMed  CAS  Google Scholar 

  47. Kuster H, Degitz K (1993) Circulating ICAM-1 in neonatal sepsis (letter). Lancet 341(8843):506

    Article  PubMed  CAS  Google Scholar 

  48. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844): 515–518

    Article  PubMed  CAS  Google Scholar 

  49. Speer CP, Rethwilm N, Gahr M (1987) Elastase-α1-proteinase inhibitor: an early indicator of septicaemia and bacterial meningitis in children. J Pediatr 111:667–671

    Article  PubMed  CAS  Google Scholar 

  50. Tegtmeyer FK, Horn C, Richter A, van Wees J (1992) Elastase alpha 1 proteinase inhibitor complex, granulocyte count, ratio of immature to total granulocyte count, and C-reactive protein in neonatal septicaemia. Eur J Pediatr 151(5): 353–356

    Article  PubMed  CAS  Google Scholar 

  51. Leclerc F, Chenaud M, Delepoulle F, Francois DJ, Alain M, Valerie H (1991) Prognostic value of C-reactive protein level in severe infectious purpura: a comparison with eight other scores. Crit Care Med 19(3): 430–432

    Article  PubMed  CAS  Google Scholar 

  52. Housinger TA, Brinkerhoff C, Warden GD (1993) The relationship between platelet count, sepsis, and survival in pediatric burn patients. Arch Surg 128(1): 65–66

    Article  PubMed  CAS  Google Scholar 

  53. Pollack M, Ruttimann U, Getson P (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116

    Article  PubMed  CAS  Google Scholar 

  54. Leclerc F, Beuscart R, Guillois B et al (1985) Prognostic factors of severe infectious purpura in children. Intensive Care Med 11(3): 140–143

    Article  PubMed  CAS  Google Scholar 

  55. Fischer GW (1988) Immunoglobulin therapy of neonatal group B streptococcal infections: an overview. Pediatr Infect Dis J 7[Suppl 5]:S13–S16

    PubMed  CAS  Google Scholar 

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© 1994 Springer-Verlag Berlin Heidelberg

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Hazelzet, J.A., de Groot, R. (1994). Sepsis-Related Problems in Pediatric Patients. In: Reinhart, K., Eyrich, K., Sprung, C. (eds) Sepsis. Update in Intensive Care and Emergency Medicine, vol 18. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-85036-3_16

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  • DOI: https://doi.org/10.1007/978-3-642-85036-3_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-85038-7

  • Online ISBN: 978-3-642-85036-3

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