Early Identification and Effective Management of Pediatric Sepsis

Inclusion Criteria: * The presence of at least two of the following four criteria, one of which must be abnormal temperature or leukocyte count: * Coreb temperature of \>38.5°C or \<36°C. * Tachycardia, defined as a mean heart rate \>2 SD above normal for age in the absence of external stimulus, chronic drugs, or painful stimuli; or otherwise unexplained persistent elevation over a 0.5- to 4-hr time period OR for children \<1 yr old: bradycardia, defined as a mean heart rate \<10th percentile for age in the absence of external vagal stimulus, β-blocker drugs, or congenital heart disease; or otherwise unexplained persistent depression over a 0.5-hr time period. * Mean respiratory rate \>2 SD above normal for age or mechanical ventilation for an acute process not related to underlying neuromuscular disease or the receipt of general anesthesia. * Leukocyte count elevated or depressed for age (not secondary to chemotherapy-induced leukopenia) or \>10% immature neutrophils * A suspected or proven (by positive culture, tissue stain, or polymerase chain reaction test) infection caused by any pathogen OR a clinical syndrome associated with a high probability of infection. Evidence of infection includes positive findings on clinical exam, imaging, or laboratory tests Exclusion Criteria: * patients without informed consent * discharge within 48 hours