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Abstract
Sepsis is a leading cause of mortality among children worldwide (Kawasaki, 2017). Variability in treatment strategies is one of many factors complicating practice. Current UK guidelines recommend bolus fluid resuscitation with 20 ml/kg within ten minutes. However, the seminal study of the Fluid Expansion as Supportive Therapy trial (Maitland et al., 2011) may have influenced current practice, and potentially a more restrictive approach is now being taken. This study was performed in a low-income setting, raising questions as to its applicability in a high-income setting. The FiSh study (Inwald et al., 2019) highlights the challenges of conducting a similar study in high-income settings. The complexity of the altering physiology at different ages complicates this further, and therefore a review of current local practice was indicated.
This is a retrospective study involving 50 infants, with a working diagnosis of sepsis, treated in a tertiary paediatric emergency department resuscitation room, from November 2015 – March 2018. Data was collected regarding the volume, type, aliquots and timing of fluid, together with lactate levels. The acuity and length of admission were the measurable outcomes.
50% of infants were under fluid resuscitated against the currently recommended guidelines (figure 1). Of the infants that were under fluid resuscitated, 60% required no further fluid resuscitation (figure 2). There was no correlation between fluid resuscitation practice and admission length, although the majority of patients (84%) had admissions of less than one week. 2% of infants had positive blood cultures.
Results of total fluid given
Further fluid resuscitation following initial fluid
This study adds value to clinicians working in paediatrics by demonstrating that fluid resuscitation of infants specifically needs careful consideration and further investigation. Discussion surrounding the aetiology and prevalence of sepsis in high-income settings is indicated. A theory that infants should be considered a unique entity within the general field of paediatrics is proposed.