• Vol. 43 No. 5, 267–274
  • 15 May 2014

The Golden Hours in Paediatric Septic Shock—Current Updates and Recommendations

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ABSTRACT

Introduction: : Paediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the “golden hours”, has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis.

Materials and Methods: A comprehensive literature search was performed via PubMed using the search terms: ‘sepsis’, ‘septic shock’, ‘paediatric’ and ‘early goal-directed therapy’. Original and review articles were identified and selected based on relevance to this review.

Results: Early recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial.

Conclusion: The use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.


Sepsis in children is a global health issue. The Global Health Observatory estimates that 58% of deaths in children under 5 years old are caused by infectious diseases. Mortality increases as sepsis progresses to septic shock. The implementation of childhood vaccination programmes and the advent of vaccines such as Haemophilus influenza and pneumococcal vaccines have resulted in a change in the types of microbial agents responsible for sepsis. Previously common causes of septic shock such as Haemophilus influenza type b, Neisseria meningitides and Streptococcus pneumoniae, are now less commonly seen in countries with widespread immunisation programmes. Changing trends in pneumococcal serotypes have also been reported. Despite that, the incidence of sepsis in children has not declined and constitutes a significant economic burden. The World Federation of Pediatric Intensive Care and Critical Care Societies (WFPICCS) has recently launched the Global Sepsis Initiative, a quality improvement programme at an attempt to improve sepsis outcome in children, targeting countries with different level of resources.

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