Paediatric SIRS Criteria
Tick criteria present. ≥2 criteria = SIRS. SIRS + suspected infection = Sepsis.
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Paediatric Systemic Inflammatory Response Syndrome (SIRS) is a clinical diagnosis based on the presence of two or more abnormal vital sign or laboratory criteria adapted for the age-specific physiology of children. Unlike adults, children's normal ranges for heart rate, respiratory rate, and white blood cell count change dramatically from birth through adolescence, making age-stratified thresholds essential for accurate SIRS identification. The 2005 International Paediatric Sepsis Consensus Conference (IPSCC) established the widely used paediatric SIRS criteria: temperature above 38.5°C or below 36°C; heart rate greater than 2 standard deviations above the mean for age (or below the mean for age in children under 1 year, bradycardia being a particularly ominous sign); respiratory rate greater than 2 standard deviations above mean for age, or mechanical ventilation for an acute process; and white blood cell count elevated or depressed for age, or greater than 10% immature neutrophils (bands). Paediatric Sepsis is defined as SIRS plus a suspected or confirmed infection. Severe Paediatric Sepsis is sepsis plus organ dysfunction, hypoperfusion, or hypotension. Paediatric Septic Shock is sepsis with cardiovascular dysfunction despite adequate fluid resuscitation. Recognition of SIRS in children is complicated by the fact that fever and tachycardia are extremely common presentations of self-limiting viral illnesses, making clinical context and repeated assessment crucial. Age-specific thresholds for all vital signs are central to avoiding both over- and under-diagnosis.
Paediatric SIRS = 2 or more of: (1) Temp >38.5°C or <36°C; (2) HR >2SD above mean for age; (3) RR >2SD above mean for age or PaCO2 <32 mmHg; (4) WBC >12 or <4 x10^9/L or >10% band forms
- 1Obtain a complete set of vital signs including temperature, heart rate (HR), respiratory rate (RR), blood pressure (BP), and oxygen saturation.
- 2Compare each vital sign against the age-specific normal range using the IPSCC paediatric reference thresholds.
- 3Check white blood cell count from a full blood count with differential; note whether bands (immature neutrophils) exceed 10%.
- 4Apply the SIRS criteria: count how many of the four criteria are met (temperature, HR, RR, WBC).
- 5If 2 or more criteria are met, SIRS is present. Assess for a source of infection (clinical history, examination, cultures).
- 6If SIRS is present with suspected or confirmed infection: diagnose Paediatric Sepsis; initiate Surviving Sepsis Campaign (paediatric) bundle — blood cultures, IV antibiotics within 1 hour, IV fluid bolus.
- 7Assess for organ dysfunction (Glasgow Coma Score, creatinine, bilirubin, lactate, platelet count, coagulation); if present, classify as Severe Sepsis. If cardiovascular dysfunction persists after 40 mL/kg fluid resuscitation, classify as Septic Shock.
Likely viral illness; SIRS present but sepsis not confirmed. Monitor closely; investigate if not improving at 24–48 hours.
Temperature >38.5°C and HR >2SD above mean for 18 months (normal HR 100–140 bpm). WBC and RR within normal limits for age. SIRS is present but requires clinical judgement about infection probability before committing to full sepsis workup.
Immediate empirical IV cefotaxime + dexamethasone; LP after CT if neurologically stable
All four SIRS criteria positive. Non-blanching rash is a meningococcal emergency. Treatment must not be delayed for investigations. Mortality without immediate antibiotics exceeds 20%.
IV amoxicillin + monitoring; reassess for severe sepsis criteria (organ dysfunction)
Three of four SIRS criteria positive. Clinical source (pneumonia) confirmed. No current organ dysfunction, but SpO2 94% warrants supplemental oxygen and close monitoring.
Neonatal sepsis can deteriorate catastrophically within hours; a low WBC in neonates is more ominous than a high one
All four criteria met. WBC of 3.2 x10^9/L is below the neonatal threshold of 5. Leukopenia in neonates may reflect bone marrow consumption by overwhelming infection. Empirical antibiotics must be started within 30–60 minutes.
Emergency department triage to identify children requiring urgent sepsis workup and empirical antibiotics., representing an important application area for the Pediatric Sepsis Sirs in professional and analytical contexts where accurate pediatric sepsis sirs calculations directly support informed decision-making, strategic planning, and performance optimization
Paediatric intensive care unit admission criteria and monitoring of treatment response., representing an important application area for the Pediatric Sepsis Sirs in professional and analytical contexts where accurate pediatric sepsis sirs calculations directly support informed decision-making, strategic planning, and performance optimization
Education and training of paediatric nurses and doctors in early sepsis recognition., representing an important application area for the Pediatric Sepsis Sirs in professional and analytical contexts where accurate pediatric sepsis sirs calculations directly support informed decision-making, strategic planning, and performance optimization
Quality improvement audits measuring time-to-antibiotics in paediatric sepsis cases., representing an important application area for the Pediatric Sepsis Sirs in professional and analytical contexts where accurate pediatric sepsis sirs calculations directly support informed decision-making, strategic planning, and performance optimization
Academic researchers and university faculty use the Pediatric Sepsis Sirs for empirical studies, thesis research, and peer-reviewed publications requiring rigorous quantitative pediatric sepsis sirs analysis across controlled experimental conditions and comparative studies
Febrile neutropenia in oncology patients
In the Pediatric Sepsis Sirs, this scenario requires additional caution when interpreting pediatric sepsis sirs results. The standard formula may not fully account for all factors present in this edge case, and supplementary analysis or expert consultation may be warranted. Professional best practice involves documenting assumptions, running sensitivity analyses, and cross-referencing results with alternative methods when pediatric sepsis sirs calculations fall into non-standard territory.
Immunocompromised children
In the Pediatric Sepsis Sirs, this scenario requires additional caution when interpreting pediatric sepsis sirs results. The standard formula may not fully account for all factors present in this edge case, and supplementary analysis or expert consultation may be warranted. Professional best practice involves documenting assumptions, running sensitivity analyses, and cross-referencing results with alternative methods when pediatric sepsis sirs calculations fall into non-standard territory.
Meningococcal disease
In the Pediatric Sepsis Sirs, this scenario requires additional caution when interpreting pediatric sepsis sirs results. The standard formula may not fully account for all factors present in this edge case, and supplementary analysis or expert consultation may be warranted. Professional best practice involves documenting assumptions, running sensitivity analyses, and cross-referencing results with alternative methods when pediatric sepsis sirs calculations fall into non-standard territory.
Post-cardiac surgery
In the Pediatric Sepsis Sirs, this scenario requires additional caution when interpreting pediatric sepsis sirs results. The standard formula may not fully account for all factors present in this edge case, and supplementary analysis or expert consultation may be warranted. Professional best practice involves documenting assumptions, running sensitivity analyses, and cross-referencing results with alternative methods when pediatric sepsis sirs calculations fall into non-standard territory.
Kawasaki disease
{'title': 'Kawasaki disease', 'body': 'Kawasaki disease presents with fever and SIRS criteria but is not caused by a conventional infection — it is a vasculitis of unknown aetiology. The key distinguishing features are the classic clinical signs (rash, conjunctivitis, cracked lips, strawberry tongue, lymphadenopathy, hand/foot oedema). Treatment is IVIG, not antibiotics.'}
| Age Group | HR (bpm) Tachycardia | RR (/min) | WBC (x10^9/L) |
|---|---|---|---|
| Neonate (0–7d) | >180 or <100 | >50 | <5 or >34 |
| Infant (7d–1yr) | >180 or <90 | >40 | <5 or >19.5 |
| Toddler (1–2yr) | >140 | >34 | <6 or >17.5 |
| Pre-school (2–5yr) | >130 | >22 | <6 or >15.5 |
| School age (6–12yr) | >120 | >18 | <4.5 or >13.5 |
| Adolescent (13–18yr) | >110 | >14 | <4.5 or >11 |
Why are the vital sign thresholds different for children of different ages?
Children's baseline physiological parameters change markedly with age. A heart rate of 160 bpm is normal in a newborn but concerning in a 10-year-old. The IPSCC defined age-specific thresholds for neonates (0–7 days), infants (1 week–1 year), toddlers (1–2 years), pre-school age (2–5 years), school age (6–12 years), and adolescents (12–18 years) to ensure thresholds are clinically meaningful.
What is the difference between paediatric SIRS and adult SIRS?
The overall framework (2 of 4 criteria) is similar, but the threshold values differ substantially. Adult SIRS uses fixed thresholds (HR >90, RR >20, T >38 or <36, WBC >12 or <4). Paediatric SIRS requires age-stratified thresholds because adult thresholds are entirely inappropriate for neonates and infants. Additionally, temperature abnormality must be one of the two criteria in paediatric SIRS.
Is SIRS the same as sepsis?
No. SIRS is a non-specific systemic response to any significant stressor — infection, trauma, burns, pancreatitis, or even strenuous exercise. Sepsis requires SIRS plus a suspected or confirmed source of infection. SIRS alone in the absence of infection is not sepsis and does not require antibiotics. This is particularly important in the context of pediatric sepsis sirs calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise pediatric sepsis sirs computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
What is the Surviving Sepsis Campaign paediatric bundle?
The Surviving Sepsis Campaign (SSC) paediatric guidelines (2020) recommend: recognition within 1 hour; blood cultures before antibiotics; empirical broad-spectrum antibiotics within 1 hour of recognition; isotonic crystalloid fluid resuscitation (10 mL/kg boluses titrated to haemodynamic response, reassessing after each bolus); early vasopressors for fluid-refractory shock; and corticosteroids for catecholamine-resistant shock.
Why is bradycardia an ominous sign in infants?
Unlike adults who maintain cardiac output by increasing heart rate or stroke volume, infants are heavily rate-dependent for maintaining cardiac output. Bradycardia in an ill infant (heart rate below the lower limit for age) signals imminent cardiovascular collapse and is a paediatric emergency requiring immediate response. This is particularly important in the context of pediatric sepsis sirs calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise pediatric sepsis sirs computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
What are the most common organisms causing paediatric sepsis?
In neonates (first 28 days): Group B Streptococcus, Escherichia coli, Listeria monocytogenes. In infants and young children: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae (in unvaccinated children), Staphylococcus aureus. In immunocompromised children: gram-negative bacteria, Candida species, and opportunistic organisms. This is particularly important in the context of pediatric sepsis sirs calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise pediatric sepsis sirs computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
Can SIRS occur without fever?
Yes. Hypothermia (temperature below 36°C) also meets the temperature criterion. Neonates in particular may present with hypothermia rather than fever during sepsis, as their thermoregulatory mechanisms are immature. Immunocompromised children may also present with afebrile sepsis, making clinical vigilance essential. This is particularly important in the context of pediatric sepsis sirs calculations, where accuracy directly impacts decision-making. Professionals across multiple industries rely on precise pediatric sepsis sirs computations to validate assumptions, optimize processes, and ensure compliance with applicable standards. Understanding the underlying methodology helps users interpret results correctly and identify when additional analysis may be warranted.
How does paediatric sepsis differ from neonatal sepsis?
Neonatal sepsis is often classified separately into early-onset (within 72 hours of birth, usually from maternal transmission of organisms like GBS or E. coli) and late-onset (after 72 hours, often hospital-acquired or community organisms). Neonatal presentation is notoriously non-specific — poor feeding, lethargy, temperature instability, or grunting — making a high index of suspicion essential.
Proffstips
In any child with fever, always check for non-blanching rash (press a glass against a petechial or purpuric rash — if it does not blanch, it is non-blanching and may indicate meningococcal disease). This is a time-critical emergency where seconds save lives — administer IM/IV benzylpenicillin immediately.
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Paediatric sepsis kills approximately 3 million children globally each year, with over 95% of deaths occurring in low- and middle-income countries. The introduction of the Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccines has reduced sepsis mortality in children by an estimated 30–50% in countries with high vaccination coverage.
Referenser
- ›Goldstein B et al — International Paediatric Sepsis Consensus Conference 2005
- ›Weiss SL et al — Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children 2020
- ›NICE — Sepsis: Recognition, Diagnosis and Early Management (NG51)
- ›RCPCH — Paediatric Sepsis: Recognition and Treatment