Epidemiology

Global data on sepsis in children are incomplete, but it is estimated that infection accounts for the majority of deaths in children aged under 5 years.[4] Mortality for children with sepsis ranges from 4% to 50% depending on illness severity, risk factors, and geographical location.[6] In 2017, the World Health Organization reported the following leading causes of death among children aged under 5 years: preterm birth complications, acute respiratory infections, intrapartum-related complications, diarrhoea, and congenital abnormalities.[4] In post-neonatal children under the age of 5, the main causes of death were acute respiratory infections and diarrhoea.[4]

The Global Burden of Disease Study estimated that, in 2017, there were 20.3 million (95% uncertainty interval [UI] 14.0 to 29.7) incident sepsis cases worldwide among children younger than 5 years, and 4.9 million (3.5 to 7.0) incident sepsis cases among children and adolescents aged 5-19 years.[13] Two large cohort studies have described the annual incidence of 'severe sepsis' in children (defined as <20 years of age) admitted acutely to hospitals in seven US states.[14][15] These studies showed a rising annual incidence of 'severe sepsis' between 1995 and 2005 (0.56-0.89 cases/1000 children, respectively, across all age groups).[15] The incidence of 'severe sepsis' in these cohorts was significantly higher in younger age groups (incidence in the neonatal age group and infants aged <1 year was 9.7 and 2.25 cases/1000 children compared with 0.23-0.52 in children aged 1-19 years). 'Severe sepsis' was also more common in children with comorbidities. Despite the rising incidence of 'severe sepsis', the case fatality rate has fallen from 10.3% to 8.9%.[15]

One systematic review estimated a global burden of 1.2 million cases of childhood sepsis per year.[16] Published studies have also described the prevalence of 'severe sepsis' among patients in paediatric intensive care units (ICUs). In one large, multi-centre, cohort study using data from 42 ICUs in the US, the prevalence of 'severe sepsis' was reported as 7.7% of admissions. This is consistent with other epidemiological data from the US, and confirms a rising prevalence of 'severe sepsis' with a falling risk of mortality.[17] A large international prevalence study (Sepsis PRevalence, OUtcomes, and Therapies [SPROUT]) of 'severe sepsis' found the global prevalence of 'severe sepsis' in paediatric ICUs to be 8.2% (95% confidence interval [CI] 7.6% to 8.9%).[18] However, the true incidence of sepsis in children is likely to be significantly underestimated due to under-reporting and how infections are clinically coded in hospital.[19]

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