ReviewThe global burden of paediatric and neonatal sepsis: a systematic review
Introduction
A recent resolution by WHO listed sepsis as a key health-care priority for the coming decade,1 recognising that sepsis—defined as life-threatening infection due to a dysregulated host response to infection2—is a major contributor to global morbidity and mortality.3, 4 Peak sepsis incidence and mortality occur in the extreme age groups, with newborn babies, young children, and elderly people at highest risk.5, 6, 7 Despite improvements in care, neonatal and paediatric mortality due to severe sepsis is around 11% in high-income countries.8
Global burden of disease studies have extensively characterised the burden of severe infections on childhood mortality in low-income countries.9 In 2013, 2·3 million children under the age of 5 years died from infectious diseases such as lower respiratory infection (708 600 deaths), diarrhoea (474 900 deaths), and malaria (570 000 deaths). These reports commonly classify the cause of death by type of infection, rather than by presence of sepsis, which is the common final pathophysiological pathway to organ dysfunction and death from most infectious diseases.10 Although single studies have reported the incidence of population-level sepsis in high-income countries, data on global incidence of paediatric sepsis are absent.
The WHO resolution1 urges member states to measure the prevalence of sepsis, and to develop and implement monitoring and evaluation tools for sepsis. The resolution also requests that the Director-General of WHO publish a report on sepsis and its global consequences by the end of 2018. Comprehensive knowledge of the global burden of sepsis is crucial to justify, design, and monitor initiatives on prevention, diagnosis, and treatment of this time-critical and often preventable disease.
Our primary aim was to systematically review the available evidence on population-based sepsis incidence across paediatric age groups. Our secondary aim was to do a meta-analysis of population-based paediatric sepsis data to estimate the global number of sepsis cases in children and neonates.
Section snippets
Search strategy and selection criteria
We did a systematic literature search and review according to a predesigned protocol (see appendix). Data collection was based on three strategies: a search for published or unpublished (grey) literature in international databases; a manual search of reference lists of articles identified as a result of the database search, and other relevant articles identified by the authors; and, queries to national experts in selected regions where reliable data were unavailable. 13 international and
Results
Our search yielded 1270 results, of which 214 studies were eligible for full-text screening (figure 1). 17 records were excluded due to missing full texts and of the remaining 197 studies, 174 were excluded after full-text review. 23 studies from 16 countries met the inclusion criteria. Interrater agreement (κ) was 0·591 (moderate agreement). 16 studies were from high-income countries, and seven from middle-income countries. No study from low-income countries was included. Three studies were
Discussion
To our knowledge, we provide the largest meta-analysis of population-based neonatal and paediatric sepsis epidemiology, including data from 12 middle-income and high-income countries on four continents in 15 studies reporting complete data. Heterogeneity of data was considerable, and the inclusion criteria used in the studies might have led to considerable bias. Because of insufficient data from all low-income and most middle-income countries, our estimates of global burden for neonatal and
References (45)
- et al.
Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland— a prospective population-based cohort study
Lancet Child Adol Health
(2017) - et al.
Pediatric sepsis in the developing world
J Infect
(2015) - et al.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine
Chest
(1992) - et al.
Estimation of incidence and analysis of sepsis in an area of Valencia (Spain)
An Pediatr (Barc)
(2007) - et al.
Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study
Lancet Infect Dis
(2015) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey
Lancet Infect Dis
(2017) - et al.
What is the best method for estimating the burden of severe sepsis in the United States?
J Crit Care
(2012) - et al.
Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival
Lancet
(2010) Improving the prevention, diagnosis and clinical management of sepsis
The third international consensus definitions for sepsis and septic shock (sepsis-3)
JAMA
Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations
Am J Respir Crit Care Med
Sepsis and the global burden of disease in children
JAMA Pediatr
Hospital incidence and mortality rates of sepsis
Dtsch Arztebl Int
Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care
Crit Care Med
The epidemiology of severe sepsis in children in the United States
Am J Respir Crit Care Med
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Lancet
International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics
Pediatr Crit Care Med
2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis definitions conference
Crit Care Med
Priority medicines for Europe and the world “A public health approach to innovation”. 2013 update: Background Paper 6.23 neonatal conditions
An epidemiologic survey of pediatric sepsis in regional hospitals in China
Pediatr Crit Care Med
Sepsis in Canadian children: a national analysis using administrative data
Clin Epidemiol
Cited by (0)
- †
Joint first authors