Pediatric Sepsis Primer

Age-Stratified SIRS Thresholds — Goldstein et al., Pediatr Crit Care Med 2005

Age Group	HR Tachy (bpm)	HR Brady (bpm)	RR (breaths/min)	WBC (×10³/µL)	Temp
Neonate (0–7d)	>180	<100	>50	>34	>38.5°C or <36°C
Neonate (1wk–1mo)	>180	<100	>40	>19.5 or <5	>38.5°C or <36°C
Infant (1mo–1yr)	>180	<90	>34	>17.5 or <5	>38.5°C or <36°C
Toddler (2–5yr)	>140	N/A	>22	>15.5 or <6	>38.5°C or <36°C
School Age (6–12yr)	>130	N/A	>18	>13.5 or <4.5	>38.5°C or <36°C
Adolescent (13–18yr)	>110	N/A	>14	>11 or <4.5	>38.5°C or <36°C

SIRS in pediatrics = ≥2 criteria, one of which MUST be temp or WBC abnormality. Tachycardia alone is insufficient.

Patient Input

Age

Age unit

Weight (kg)

SIRS Criteria (Goldstein 2005)

Check all abnormal values for this patient. Use age-stratified thresholds above.

Temperature > 38.5°C or < 36°C ★ Must have temp OR WBC

Tachycardia (above age threshold)

Or bradycardia for age in neonates/infants

Tachypnea (above age threshold) OR need for mechanical ventilation unrelated to neuromuscular disease/anesthesia

WBC elevated or depressed for age (see table) OR >10% immature neutrophils ★ Must have temp OR WBC

SIRS CRITERIA MET

—

Organ Dysfunction Assessment

Cardiovascular: despite IV fluid bolus ≥ 40 mL/kg — BP < 2SD below normal for age, need vasopressors, or tissue hypoperfusion

Delayed cap refill, decreased peripheral pulses, oliguria < 1 mL/kg/hr, altered mentation

Pulmonary: PaO₂/FiO₂ < 300 without congenital heart disease or pre-existing lung disease

Neurologic: GCS ≤ 11 or acute change in mental status with GCS decrease ≥ 3 from abnormal baseline

Hematologic: Platelets < 80,000/µL or INR > 2

Renal: Creatinine ≥ 2× upper limit of normal for age

Hepatic: Total bilirubin ≥ 4 mg/dL (not in neonates) or ALT > 2× ULN for age

🟣 Weight-Based Dosing Reference

Enter patient weight above to see weight-based doses.

Evidence Base

Goldstein B, et al. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005. PMID 15636651
Davis AL, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017. PMID 28509730
Weiss SL, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020. PMID 32032273
Schlapbach LJ, et al. International consensus criteria for pediatric sepsis and septic shock. JAMA 2024. PMID 38245896

🟣 YBEMUS PEM Adaptation · Guy Youngblood, MD, FACEP, FAAEM
BCM / CHRISTUS Children's Pediatric Emergency Medicine Fellowship · CCEMRP
For educational use. Not a substitute for clinical judgment.

👶 Pediatric Sepsis Primer 🟣