Sepsis in Infants and Young Children
Your child has been healthy, but now has developed a fever. You are concerned. There may have been other sick people at home. Now your child's physician tells you that your child must be hospitalized. Why can't he get over this by himself? Can you give some medicine so I can take him home? Why does he have to be in the hospital?
Why did my child get sick?
You may have learned that an infant receives important antibodies against infection from his mother at birth. This protection gradually decreases and the infant grows. In addition, mothers do not provide protection against every kind of infection, so young children are always at risk. Young children do not fight infections as well as older children and adults. Serious infections can enter the bloodstream (called sepsis), or cause pneumonia, urinary infections, or infections of the brain lining (called meningitis). When an infection is strongly suspected, we must therefore act quickly and give the child antibiotics.
What is the "Sepsis Work-up?"
You may have heard the phrase "sepsis work-up" in relation to your child. This term refers to the combination of tests used to diagnose the specific cause of a child's infection, particularly whether it is a virus or a bacteria causing the infection. The sepsis work-up may include a test of blood, urine and the spinal fluid, and possibly a lung x-ray. Other tests may also be included.
Samples of body fluids are tested in two ways. First, the fluid is examined under a microscope for evidence of infection. This can be done rapidly and may suggest a specific cause for the infection. The more definitive test is to place the fluids on culture medium, place them in an incubator, and try to grow bacteria from them. This may take two or three days.
For some children, the risk of infection is high enough that antibiotic treatment is started even before results of these studies are available. As a consequence, some children will be treated even though they are eventually found to have relatively benign viral infections. If a child has a serious bacterial infection, the earlier treatment is started the better.
Lumbar Puncture or Spinal Tap
A lumbar puncture is a procedure in which we collect a sample of spinal fluid for testing. A needle is inserted into the spinal space in the lower back to remove a small amount of fluid. While the procedure may be uncomfortable, there are few if any side effects to this procedure, and it provides us important information. Local anesthesia is used to reduce the child's discomfort during the procedure.
Testing the fluid reveals whether or not the child has meningitis. More commonly, meningitis is caused by a virus and not bacteria and then does not require treatment with antibiotics. Bacterial meningitis, however, may require intravenous antibiotic treatment for an extended period of time.
Urine Collection by Catheterization
Catheterization is a procedure by which we carefully collect an uncontaminated urine sample from your child. A small tube is inserted through the urethra into the bladder. Examination of the urine may reveal the presence of infection.
Intravenous Treatment (IV)
A small catheter is placed in the child's vein, permitting us to give antibiotics directly into the child's bloodstream. The most common sites for the IV are the backs of the hands or the feet. Although the IV is awkward, it is not painful to the child and will not prevent you from holding and feeding your child as usual. We will ask you to be careful with the IV, and we restrain the child in some way to minimize movement at the IV site. We do this so the child will not have to go through the process of starting the IV again.
After urine, blood and spinal fluid samples have been collected, antibiotics can be started. Some children are found to have serious bacterial infections and require antibiotics for extended periods and possibly other specific kinds of therapy as well. Viral infections are generally less serious and are not affected by antibiotic treatment. If after 48 to 72 hours no bacteria are cultured from any of the samples, the illness was likely viral and the antibiotics may be stopped.
The hospital staff are here to help you adjust to being in the hospital, and in particular, to help you continue bonding with your child. Please let us know how we can help you and feel free to ask any questions that may arise.