Septic shock in children. Definition, epidemiology and management.

Sepsis (with or without shock), the most common life-threatening condition in children, is becoming increasingly prevalent. There is no universal defi nition of septic shock. According to Hayden's adaptation to children of the terms used for adults, <<sepsis>> designates documented infection and <<se ptic shock>> sepsis with persistent hypotension despite adequate fluid resu scitation. The management of septic shock rests on appropriate antimicrobia l therapy, fluid expansion, and alpha-adrenoceptor agonists. After the neon atal period, fluid expansion should be conducted at a rapid pace, preferabl y using hydroxyethylstarch. Dopamine should be used as first-line therapy i n patients who fail to respond to fluid expansion. Other treatments (renal support techniques, inflammation mediator antagonists, antiinflammatory age nts, antioxidants) have been advocated but none has been proved effective.