Suspected sepsis in under 16s: recognition, diagnosis and early management

Think 'could this be sepsis?' if a person presents with symptoms or signs that indicate possible infection. [2016]

Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature. [2016]

Pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour. [2016]

Assess people who might have sepsis with extra care if there is difficulty in taking their history, for example people with English as a second language or people with communication difficulties (such as learning disabilities or autism). [2016, amended 2024]

Assess people with any suspected infection to identify:

• possible source of infection (see the recommendations on finding and controlling the source of infection)

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis)

• any indications of clinical concern, such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

During a remote assessment, when deciding whether to offer a face-to-face-assessment and, if so, on the urgency of it, identify:

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis) and

• indications of clinical concern such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

Use a structured set of observations to assess people in a face-to-face setting to stratify risk if sepsis is suspected. (See the recommendations on face-to-face assessment and grading risk in people with suspected sepsis). [2016]

Consider using an early warning score to assess people under 16 with suspected sepsis, in any setting. [2016, amended 2024]

Suspect neutropenic sepsis in people who become unwell and:

• are having or have had systemic anticancer treatment within the last 30 days

• are receiving or have received immunosuppressant treatment for reasons unrelated to cancer. Use clinical judgement (based on the person's specific condition, medical history, or both, and on the treatment they received) to determine whether any past treatment may still be likely to cause neutropenia. [2016, amended 2024]

Refer people with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care. [This recommendation is from NICE's guideline on neutropenic sepsis in people with cancer.] [2012]

Treat people with neutropenic sepsis, regardless of cause, in line with NICE's guideline on neutropenic sepsis in people with cancer. [2016, amended 2024]

Take into account the factors that may increase the risk of developing sepsis or sepsis not being identified promptly. These include:

• age: being under 1 year

• ethnicity: being from an ethnic minority background

• clinical features such as:

  • frailty (that is, living with chronic illnesses, disabilities or complex care needs)

  • multimorbidities or severe chronic conditions

  • impaired immune function because of illness or medical treatment

  • surgery or invasive procedures in the past 6 weeks

  • indwelling catheters

  • repeated antibiotic use

  • breach of skin integrity

• communication difficulties, such as with people:

  • with learning difficulties

  • with cognitive impairment

  • who need an interpreter

• drugs or alcohol misuse

• social, economic or environmental factors such as:

  • homelessness

  • living in deprived areas.
    
    See also recommendation 1.1.9 on when to suspect neutropenic sepsis. [2016]
    
    For specific risk in pregnant or recently pregnant young people, see the NICE guideline on suspected sepsis in pregnant or recently pregnant people.

Take into account the following risk factors for early-onset neonatal infection:

• Major risk factor:

  • Suspected or confirmed infection in another baby in the case of a multiple pregnancy.

• Other risk factors:

  • Invasive group B streptococcal infection in a previous baby or maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

  • Pre-term birth following spontaneous labour before 37 weeks' gestation.

  • Confirmed rupture of membranes for more than 18 hours before a pre-term birth.

  • Confirmed prelabour rupture of membranes at term for more than 24 hours before the onset of labour.

  • Maternal intrapartum fever higher than 38°C if there is suspected or confirmed bacterial infection.

  • Clinical diagnosis of chorioamnionitis.
    
    [This recommendation is from NICE's guideline on neonatal infection.] [2021]