Improving the outcome of septic shock in children

Sepsis is an important cause of pediatric morbidity and mortality. Improvin g the outcome of pediatric sepsis requires diverse efforts, including preve ntion, early recognition, improvements in early management and transport, a nd physiology-directed care. Awareness that septic shock represents a patho physiologic host response to infection has prompted investigation of immune mediators and coagulation factors as potential targets for anti-sepsis the rapies. Advancements thus far include: the potential prevention of neonatal sepsis with granulocyte colony-stimulating factor; recognition of clindamy cin as a potential inhibitor of endotoxin release; improved outcome from me ningococcal disease in children treated with bactericidal/permeability-incr easing protein (rBPI(21)); and improved outcome from sepsis in premature in fants treated with pentoxifylline. Further randomized controlled studies of immunomodulatory agents are indicated and a few are in progress. Current s tudies on genetic propensities in cytokine and coagulation protein expressi on may explain variability in patient outcomes and eventually lead to genom ics-based therapeutics. Curr Opin Infect Dis 13:253-258. (C) 2000 Lippincot t Williams & Wilkins.