Patient handout

Pediatric sepsis / septic shock

PRODUCTION

1. Your condition

This handout is for pediatric sepsis / septic shock. Your care team identified this based on: suspected infection + age-based vital sign derangement + organ dysfunction (phoenix criteria, schlapbach jama 2024).

Other reasons your team may use this plan: age-based hypotension or shock signs (cap refill >3 s, mottling, ams, cold extremities) per ssc 2020; lactate >2 with infection in a child (ssc 2020 hour-1 bundle); fever / hypothermia with ams in a child (ssc 2020).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ampicillin	50-100 mg/kg/dose IV q6-12h (age + weight dependent)	IV	q6-12h	Listeria + GBS coverage (SSC 2020 neonatal tier)
gentamicin	4-5 mg/kg/dose IV q24-36h (extended interval per gestational age)	IV	q24-36h	Gram-negative synergy with ampicillin (SSC 2020 neonatal tier)
cefotaxime	50 mg/kg/dose IV q6-12h	IV	q6-12h	Use cefotaxime not ceftriaxone in neonates (bilirubin displacement risk; SSC 2020)
acyclovir	20 mg/kg/dose IV q8h	IV	q8h	Cover neonatal HSV until excluded; high mortality if missed (AAP Red Book 2024)
vancomycin	15 mg/kg/dose IV q6-18h (gestational age dependent)	IV	per nomogram	Add-on for MRSA / CoNS in NICU / line settings (SSC 2020)

Plan: Pediatric sepsis empiric antibiotics — age-tiered

3. When to call your provider

Contact your care team if any of the following happen:

New fever > 38.5 OR recurrent symptoms within 4 weeks of discharge → return to ED, blood culture, source-directed workup (SSC peds 2020)
New focal neurological signs OR seizures → urgent neuro + neuroimaging; route to peds.status_epilepticus.v1 if seizures (AAP)
Functional decline at follow-up (FSS worsening) → developmental peds + PT/OT urgent (Choong PEDAL series)
Caregiver PCL-5 elevated or PHQ-9 ≥ 15 → mental-health urgent referral; child PICU-Family syndrome support (Pinto Survivor Outcomes)
Suspected immunodeficiency (≥ 2 serious infections in 12 mo OR unusual pathogen) → clinical immunology urgent referral (AAP)
Hearing loss confirmed on audiology post-meningitis → ENT + audiology + speech therapy + early-intervention referral (IDSA meningitis 2024; AAP)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Persistent shock signs (hypotension, AMS, lactate >4, CRT >3 s, mottling) after 40-60 mL/kg fluid resuscitation(life-threatening)
Cold extremities + CRT >3 s + narrow pulse pressure + mottling
Warm extremities + bounding pulses + flash CRT + wide pulse pressure
Rapidly spreading purpura with shock — meningococcaemia or DIC(life-threatening)
Neonate with temperature instability, poor feeding, lethargy, apnoea, or shock(life-threatening)
Lactate not down-trending after 2 h despite resuscitation
Phoenix sepsis score ≥ 4 with active vasopressor support — high-mortality stratum (~ 30% 90-d mortality) per Phoenix 2024 derivation cohort (Schlapbach JAMA 2024 PMID 38245901; Sanchez-Pinto JAMA 2024 PMID 38245890)(life-threatening)
Clinical assessment cannot distinguish warm vs cold shock phenotype at 1 h post-bundle (mixed features OR ambiguous perfusion exam) — drives vasoactive selection ambiguity
MAP < age-based threshold despite norepinephrine 0.1-0.5 µg/kg/min OR epinephrine 0.3 µg/kg/min — catecholamine-resistant septic shock (SCCM peds 2020)(life-threatening)
Age < 28 d + ≥ 1 of: vesicles, seizures, hypothermia, hepatitis pattern (AST/ALT > 100), encephalopathy, maternal genital HSV history — neonatal HSV until excluded (AAP Red Book 2024)(life-threatening)
Age-tiered empiric antibiotics not delivered within 1 h of sepsis recognition (or within 3 h for sepsis without shock per SSC peds 2020 Hour-1 bundle window)

5. Follow-up

Post-sepsis goals-of-care discussion; PICS-p screen at 1-3 months; cognitive / functional rehab; review and de-escalate abx; outpatient ID f/u for endocarditis / osteomyelitis; immunisation catch-up

6. Sources

Guideline: Surviving Sepsis Campaign Pediatrics 2020 (Weiss et al, Pediatr Crit Care Med 2020) + Phoenix sepsis criteria 2024 (Schlapbach + Sanchez-Pinto JAMA 2024) + PALS 2020/2024 + FEAST trial contextualisation