Study looks at sepsis and purpura in children

While survival rates for sepsis have increased over the past two decades, children under four and those in adolescence remain highly susceptible to the condition.

Researchers in The Netherlands have now demonstrated that age and to a lesser extent, gender, are critical factors in whether or not a child sufferer will develop a more severe disease state and survive or not. These findings could help to improve the treatment of sepsis and improve survival rates further still.

Writing in the online open access journal Critical Care, Jan Hazelzet and colleagues at the Erasmus MC-Sophia Paediatric Intensive Care Unit (PICU) in Rotterdam describe their study of almost 300 children admitted with sepsis and purpura (red patches caused by bleeding under the skin) between 1988 and 2006. The researchers recorded the age, gender, ethnic origin, severity of condition, therapy, and survival of the patients. They then pooled the data and analyzed the outcomes retrospectively.

The results showed that the fatality rate from sepsis and purpura was 15.7%. However, during the study period, they observed a marked improvement in the numbers of children surviving sepsis. Nevertheless, they found that younger children were affected more severely and fatality rate was higher (4.3 times) for those under the age of three years. They found no difference in fatality rates between boys and girls, but boys were admitted to the PICU for longer periods and had more severe symptoms. The team found that the course of sepsis and purpura was not related to a child's ethnic origin.

In almost all cases, the infection that led to sepsis was Neisseria meningitidis, the bacterium commonly known as meningococcus. The team also reports how the drugs used to treat sepsis changed during the course of the study. There has been a marked reduction in the use of dopamine and a concomitant increase in the use of dobutamine, norepinephrine and corticosteroids to treat sepsis. "The finding of the important influence of young age and to a lesser extent gender can lead to a better understanding of the disease, which in turn can lead to better therapy", says Jan Hazelzet.

Sepsis is a serious medical condition triggered by infection, which leads to body-wide inflammation, fever, increased pulse and breathing, and potentially organ failure and death. Each year, more than 750,000 people in the USA will develop severe sepsis, and more than 215,000 will die from the condition. In the UK, sepsis kills around 30,000 people annually.

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