Epidemiology

The Global Burden of Disease Study estimated that, in 2017, there were 20.3 million (95% uncertainty interval [UI] 14.0 to 29.7) incident sepsis cases worldwide among children younger than 5 years, and 4.9 million (3.5 to 7.0) incident sepsis cases among children and adolescents ages 5-19 years.[13] Two large cohort studies have described the annual incidence of "severe sepsis" in children (defined as <20 years of age) admitted acutely to hospitals in seven US states.[14][15] These studies showed a rising annual incidence of "severe sepsis" between 1995 and 2005 (0.56 to 0.89 cases/1000 children, respectively, across all age groups).[15] The incidence of "severe sepsis" in these cohorts was significantly higher in younger age groups (incidence in the neonatal age group and infants ages <1 year was 9.7 and 2.25 cases/1000 children compared with 0.23-0.52 in children ages 1-19 years). "Severe sepsis" was also more common in children with comorbidities. Despite the rising incidence of "severe sepsis", the case fatality rate has fallen from 10.3% to 8.9%.[15]

One systematic review estimated a global burden of 1.2 million cases of childhood sepsis per year.[16] Published studies have also described the prevalence of "severe sepsis" among patients in pediatric intensive care units (ICUs). In one large, multicenter, cohort study using data from 42 ICUs in the US, the prevalence of "severe sepsis" was reported as 7.7% of admissions. This is consistent with other epidemiologic data from the US, and confirms a rising prevalence of "severe sepsis" with a falling risk of mortality.[17] A large international prevalence study (Sepsis PRevalence, OUtcomes, and Therapies [SPROUT]) of "severe sepsis" found the global prevalence of "severe sepsis" in pediatric ICUs to be 8.2% (95% confidence interval [CI] 7.6% to 8.9%).[18] However, the true incidence of sepsis in children is likely to be significantly underestimated due to under-reporting and how infections are clinically coded in hospital.[19]

Global data on sepsis in children are incomplete, but it is estimated that infection accounts for the majority of deaths in children aged under 5 years.[4] Mortality for children with sepsis ranges from 4% to 50% depending on illness severity, risk factors, and geographical location.[6] In 2017, the World Health Organization reported the following leading causes of death among children aged under 5 years: preterm birth complications, acute respiratory infections, intrapartum-related complications, diarrhea, and congenital abnormalities.[4] In postneonatal children under the age of 5, the main causes of death were acute respiratory infections and diarrhea.[4]

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