Early Management of Neonatal - Pediatric Septic Shock



Early Management of Neonatal - Pediatric Septic Shock

Submitted by the Section on Critical Care by Vicki Montgomery, MD, FAAP, FCCM

June 9, 2008

Since 2002, clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock have helped guide management of this entity in children. The guidelines address fluid management, intravascular catheters and monitoring, cardiovascular drug infusion support, hydrocortisone replacement, and several other therapeutic options. Early and aggressive fluid therapy has been associated with improved outcomes. The practice parameters include the administration of up to 60 mL/kg within the first hour.

Rapid fluid administration is feasible in the neonatal and pediatric population, especially those children weighing < 40 kg. In 2008, the results of a study investigating the impact of early reversal of Pediatric-Neonatal septic shock by community physicians were published in Pediatrics. Early reversal of shock was associated with improved outcome. Each additional hour of persistent shock was associated with a > 2 fold increase in the odds of mortality rate. Non-survivors, compared with survivors, received less fluid therapy and more inotropic therapies. Resuscitation practice was consistent with ACCM-PALS Guidelines in only 30% of patients. When practice was in agreement with the guidelines, a lower mortality was observed (8% vs 38%). Because early and appropriate therapy for septic shock is not routinely implemented by community physicians but yet has such a positive impact on survival when provided, early management of neonatal and pediatric shock is an important CME topic for the AAP membership.

Carcillo JA, Fields AI, Task Force Committee Members. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002;30:1365-1378.

Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327.

Stoner MJ, Goodman DG, Cohen DM, et al. Rapid fluid resuscitation in pediatrics: testing the American College of Critical Care Medicine Guideline. Ann Emerg Med. 2007;50:601-607.

Han YY, Carcillo JA, Dragotta MA, et al. Early Reversal of Pediatric-Neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003;112:793-799.

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