Susceptibility to childhood sepsis, contemporary management, and future directions

IF 19.9 1区 医学 Q1 PEDIATRICS Lancet Child & Adolescent Health Pub Date : 2024-08-12 DOI:10.1016/S2352-4642(24)00141-X
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Abstract

Sepsis disproportionally affects children across all health-care settings and is one of the leading causes of morbidity and mortality in neonatal and paediatric age groups. As shown in the first paper in this Series, the age-specific incidence of sepsis is highest during the first years of life, before approaching adult incidence rates during adolescence. In the second paper in this Series, we focus on the unique susceptibility of paediatric patients to sepsis and how the underlying dysregulated host response relates to developmental aspects of children's immune system, genetic, perinatal, and environmental factors, and comorbidities and socioeconomic determinants of health, which often differ between children and adults. State-of-the-art clinical management of paediatric sepsis is organised around three treatment pillars—diagnosis, early resuscitation, and titration of advanced care—and we examine available treatment guidelines and the limitations of their supporting evidence. Serious evidence gaps remain in key areas of paediatric sepsis care, especially surrounding recognition, common interventions, and survivor support, and to this end we offer a research roadmap for the next decade that could accelerate targeted diagnostics and personalised use of immunomodulation. However, improving outcomes for children with sepsis relies fundamentally on systematic quality improvement in both recognition and treatment, which is the theme of the third paper in this Series. Digital health, as shown in the fourth and final paper of this Series, holds promising potential in breaking down the barriers that hinder progress in paediatric sepsis care and, ultimately, global child health.

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儿童败血症的易感性、当代管理和未来方向
在所有医疗机构中,败血症对儿童的影响都不成比例,是新生儿和儿科年龄组发病和死亡的主要原因之一。正如本系列的第一篇论文所示,败血症的特定年龄发病率在生命的最初几年最高,然后在青春期接近成人发病率。在本系列的第二篇论文中,我们将重点讨论儿科患者对败血症的独特易感性,以及潜在的失调宿主反应与儿童免疫系统的发育、遗传、围产期和环境因素、合并症和社会经济健康决定因素之间的关系,这些因素在儿童和成人之间往往存在差异。儿科败血症的最新临床治疗方法围绕三大治疗支柱展开--诊断、早期复苏和高级护理滴定--我们研究了现有的治疗指南及其支持证据的局限性。在儿科败血症护理的关键领域,尤其是围绕识别、常用干预措施和幸存者支持等方面,仍然存在严重的证据差距,为此,我们提出了未来十年的研究路线图,以加快靶向诊断和免疫调节的个性化应用。然而,改善儿童败血症患者的预后从根本上说有赖于系统地提高识别和治疗的质量,这也是本系列第三篇论文的主题。正如本系列的第四篇也是最后一篇论文所示,数字医疗在打破阻碍儿科败血症治疗进展的障碍,最终实现全球儿童健康方面具有广阔的前景。
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来源期刊
Lancet Child & Adolescent Health
Lancet Child & Adolescent Health Psychology-Developmental and Educational Psychology
CiteScore
40.90
自引率
0.80%
发文量
381
期刊介绍: The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood. This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery. Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.
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