Join us on Tuesday 1st May for a webchat on Sepsis with Dr Ed Gaynor

[RachelMumsnet]

Following on from this thread we’ve organised a webchat about sepsis with Dr Ed Gaynor.

Ed has been a paediatrician for 10 years looking after babies and children, working in London and the South East of England. He now specialises in paediatric gastroenterology - problems with a child’s digestive system.

He is a clinical fellow for the National Medical Director for the NHS in England, and has helped to develop resources to enable parents to identify when a child might be unwell. Such as the NHS Choices video: “Spotting sepsis in the Under 5s”

Having spent a career diagnosing and treating children with severe infections, he would like to use his experience to help mumsnetters to learn how to identify signs and symptoms of sepsis early.

Sepsis is a rare but serious complication of an infection, where the body’s immune system goes into overdrive, setting off a series of reactions that can lead to a body’s organ to fail, and in some cases, death. The aim of this webchat is to empower parents with the knowledge they need to recognise the potentially deadly symptoms, so they can spot sepsis as early as possible and seek urgent medical help. Please note Dr Gaynor will not be able to diagnose any specific conditions during the webchat.

Join us on Tuesday (1st May) between 9 and 10pm where Dr Gaynor will be answering your questions on the signs and symptoms of sepsis, or post your questions in advance on this thread. More information about what to look out for in babies and children can be found on our webpage Sepsis in babies and children

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Is sepsis really rare or has the incidence of this been under reported due to ignorance?.

Isnt there some small test that can be done? To rule it out?

Its so frustrating!

if you have a self harmer at home who get infections often.
is there at form of sepsis- being the already emotional turmoil of seeking help-that can be treated at home or without going to hospital.how would you no when its gone too far.
would this be something a gp or treamtnet centre could give the required medication to heal at home where they feel safe.
fingers crossed this makes sense!

I am at risk of neutropenic sepsis, and carry an NHS card explaining this, including 24/7 contact numbers.

But reading this has made me realise that I’ve never spoken to my DC about sepsis. They’re teens - what do they need to know in case they need to spot something I might not spot accurately myself?

Evening all, a big welcome to Dr Ed Gaynor who is going to get through as many questions as possible over the next hour. Over to you Ed...

Hello everyone,

Thanks for all the questions so far and the stories you have shared. I’m really looking forwards to having a conversation with you all, about this really important topic.

Sepsis has touched so many lives and it is essential for all of us to ask: “Could this be Sepsis?” if you or your child is unwell.

I’ll answer as many questions as I can in the next hour and will end with links you can select to read more about Sepsis and how to pick it up

There are a several posts asking, “What is Sepsis?” So this seems like a good place to start.

Sepsis is a life-threatening condition that results from a body’s reaction to an infection in which the body attacks its own organs and tissues.

An infection is caused by microorganisms or “germs” (usually bacteria) invading the body, and can be limited to a particular body region (e.g. a skin infection) or can be more widespread in the bloodstream (often called “septicaemia” or “blood poisoning”).

Sepsis is a medical emergency, as it can lead to shock, multi-organ failure and death. However if caught early, the outlook is good for the vast majority of patients, but it is vital not to delay seeking medical attention.

@Fightthebear

It’s so difficult to spot though isn’t it? A junior paediatrician didn’t identify it in DS, didn’t even get a blood test done or check respiratory rate.

Her boss however had him on an iv within an hour. I know a couple of things to look out for now but he certainly didn’t seem so ill to me (he’s ok now).

Thanks for your post ‘Fightthebear.’

I completely agree with you, it is difficult to spot sepsis. But its really important for both doctors and parents to ask, “Could this be sepsis?”

Where it is difficult, is that not all infections will develop into sepsis, and those that do, may develop very quickly. So much of what we do as professional is to identify the early signs of sepsis and err on the side of caution if in doubt.

@Bearfrills

It’s so difficult to spot though isn’t it?

It really is. I developed sepsis due to retained tissue after a section. When the MW came out to do my home visit she said my symptoms were probably my milk coming in and/or tiredness. When I started vomiting later that day and couldn't get warm, I rang her and she said it must be a bug. I tried to go to bed to sleep it off but couldn't sleep because I couldn't get warm and was vomiting bile, I also told DH I was dying and gave him instructions which is when he decided that it wasn't a bug and rang OOH.

Does sepsis present differently in children to adults and is there any one single symptom that immediately pinpoints it as sepsis rather than general illness?

I’m sorry to hear about your experience ‘Bearfrills’

There are differences in how sepsis present in children and adults, particularly in the early stages. The UK Sepsis trust (sepsistrust.org/) has recommended a number of signs to look out for in children.

If your child is unwell with either a fever or very low temperature (or has had a fever in the last 24 hours), sepsis may be possible in a child who:

– Is breathing very fast
– Has a ‘fit’ or convulsion
– Looks mottled, bluish, or pale
– Has a rash that does not fade when you press it
– Is very lethargic or difficult to wake
– Feels abnormally cold to touch

In children under 5 years your should also think about sepsis if your child:

– Is not feeding
– Is vomiting repeatedly
– Hasn’t had a wee or wet nappy for 12 hours

Are there any known factors which increase (or decrease) the risk of an infection becoming sepsis?

What do you think about screening for group b step in pregnancy? Could it help prevent sepsis?

@UnmentionedElephantDildo

Are there any known factors which increase (or decrease) the risk of an infection becoming sepsis?

Hi 'UnmentionedElephantDildo'

Yes there a few significant risk factors for an infection becoming sepsis, but its can affect all of us, however healthy we have been.

These include:

• Being under 1 month of age - babies are at particular risk, so if you have a baby who has a fever >38C they should be seen urgently by a doctor and assessed.
• Following a serious injury - this includes significant burns
• If you're immunosuppressed - there are some inherited conditions, but also seen on certain medicines (eg. oral steroids) and chemotherapy
• Following abdominal surgery - especially if there is a large incision site

@jellygumboots

What do you think about screening for group b step in pregnancy? Could it help prevent sepsis?

Good evening 'jellygumboots,' really good question. For those who haven't come across Group B Streptococcus, and is commonly found on the skin of pregnant women - 15 to 40 percent of pregnant women.

It is a major cause of sepsis in newborns, and much of the monitoring that happens during and after a delivery is geared to spot signs of sepsis in the mother and child.

Screen has been introduced in some countries, and has seen a drop in this particular infection. The difficulty is that many parents would receive 'un-necessary' antibiotics, for a bug that may never affect their child.

My personal view, is that screening should be discussed and offered by the midwife or GP looking after the mother. But this is not UK policy at present.

@BoreOfWhabylon

Thanks for agreeing to do this webchat, Dr Ed.

We often have threads on here by people asking other posters for advice on whether they should go/take their child to A&E or wait until the next day to see their GP.

This is of particular concern because posters are aware of the pressures the NHS is under at the moment

Can you outline what to look out for, what needs immediate medical advice/999/A&E and what can safely be 'watch and wait'?

Thanks ‘BoreOf Whabylon’ and ‘Lollipop30’ its fairly normal for my friends to call me with the same question – “Should I take them to A&E or just watch and wait?”

Generally, I’m a strong believer that parents should trust their instincts – if you’re worried, you often know what is normal for your child or loved one,

If you child is unwell with fever (>38C) or has a low temperature (

Thanks, Dr Ed!

(I guess my 'name' here is made up of words you never thought you'd type together?)

@SunwheretheFareyou

What can we do as lay people to get our health care professionals to rule sepsis out?

Hi ‘SunwheretheFareyou’ it’s a completely reasonable concern.

However hard we try as doctors and nurses, we don’t always hear a family’s concerns as well as we should.

So firstly I would ask them – “Could this be (early) sepsis?” If they say no, ask them why they don’t think that is the case and what you should be looking out for?

If they can’t explain why not, just tell them you’re still concerned and put the onus on them to explain it more clearly or investigate. You can always ask for a ‘senior review’ or for another GPs opinion if you’re instincts tell you more is going on.

I know there are lots of concerns at the moment about the strains on the NHS, but I can promise you that there isn’t a single doctor or nurse out there who would want to actively miss a case of sepsis.

@UnmentionedElephantDildo

Thanks, Dr Ed!

(I guess my 'name' here is made up of words you never thought you'd type together?)

I think perhaps I need to get myself a more original 'Mumsnet Name'

Are there any health factors or conditions that might make someone more at risk of getting sepsis?

I wasn’t particularly aware of sepsis a couple of years ago. Now I’m hearing about it everywhere and know people affected by it IRL. Is that because it’s happening more or is it because we’re (rightly) encouraged to be alert?

@MagicSeeker

I wasn’t particularly aware of sepsis a couple of years ago. Now I’m hearing about it everywhere and know people affected by it IRL. Is that because it’s happening more or is it because we’re (rightly) encouraged to be alert?

Evening 'MagicSeeker' - fantastic question.

We are getting much better at diagnosis sepsis (affects around 1 in 1000 children) and survival is massively improved from the 1960s, where almost 97% of children with severe sepsis died in the developed world. Nowadays mortality has fallen to 4-10% in Severe Sepsis, 13-34% in children with septic shock.

So why do you see it talked about some much more in the last few years?

A lot of the increased coverage is a combination of the stellar work of the UK Sepsis Trust, Meningitis Now and others promoting its awareness. Combined with a drive to reduce 'preventable deaths'

We should all be alert to it and know what to look for

Are you more likely to get sepsis again if you've had it already?

@motherpucker

Are there any health factors or conditions that might make someone more at risk of getting sepsis?

As sepsis can be trigged by an infection in any part of your body, the risks of developing sepsis are related to you risk of developing a significant infection.

This is particularly the case if you're in hospital and you've had a significant procedure.

e.g. Recent surgery, needed a urinary catheter or have been in hospital a long time (which increased you risk of picking up infections within the hospital)

For children the particular risks include being under 1 month of age, having a condition that increases your risk of infection (e.g. Cystic Fibrosis) or on medications which suppress you immune system (particularly high-dose oral steroids like prednisone)

@SunwheretheFareyou

Isnt there some small test that can be done? To rule it out?

Its so frustrating!

Thanks for your question ‘SunwheretheFareyou’ – I’m afraid the answer is a case of “yes, but no.”

So there are studies that shows that in the early stages, that around a third of investigations can be in entirely normal – and that is because although infection is the trigger, sepsis is the result of the body’s immune system going into overdrive.

There is a campaign called Sepsis 6 that ‘PlowerOfScotland’ – advising that within an hour of an adults or children where Sepsis is strongly suspected or diagnosed clinicians should:

• Start mask or nasal oxygen - (we target this to get finger probe saturations >92% in most children, although there are some children where we aim for lower number e.g. children with specific heart or lung problems)
• Take blood cultures – this is when you take a small sample blood, and attempt to grow bacteria or fungi.
• Administer intravenous antibiotics.
• Take blood tests – such as a “blood gas” where you can quickly measure certain parameters such as the acid and lactate levels in the blood,
• Start intravenous fluid, particularly if there is low blood pressure or a raised heart rate
• Measure urine output – this is how much your child wees. This may require you to catch it with a bowl or using a catheter if your child is very unwell.

Bloods test such as your full blood count (this includes haemoglobin, white cell count and platelets) and CRP (C-reactive protein) are commonly taken and can be helpful to show signs of infection. But the diagnosis of Sepsis is often based on clinical judgement, using tests to support a provisional diagnosis.

@Eeeeek2

Are you more likely to get sepsis again if you've had it already?

Sepsis can affect anyone at any time, but some people are at higher risk than others. So if you have a chronic condition that increases your risk of infection, then you are still at risk in the future.

There has been some research that looked at how sepsis survivors do over the long-term and researchers have found that over the following year at least, some survivors are more prone to contracting another infection. Of course, when there is an infection, there is a risk of sepsis.