International Journal of Clinical Obstetrics and Gynaecology

Background: Septic shock remains a leading cause of morbidity and mortality in pediatric intensive care units (PICU), particularly in developing countries. Early identification of clinical features, risk factors, and organ dysfunction is crucial for improving outcomes. There is limited data from northern India, including Jammu & Kashmir, regarding the clinical profile, laboratory findings, management modalities, and outcomes of children admitted with septic shock.

Aim: To describe the clinical profile, laboratory findings, co-morbid conditions, management strategies, and outcomes of children aged 1 month to 12 years admitted with septic shock at the Pediatric Hospital GMC Srinagar. To identify predictors of mortality among these children.

Methods: A prospective observational study was conducted over 24 months at the Pediatric Hospital GMC Srinagar. Children aged 1 month to 12 years admitted with septic shock (as per international consensus definitions) were enrolled after informed consent. Clinical history, presenting features, co-morbidities, physical examination findings, laboratory investigations, severity scoring (pSOFA), organ dysfunction, treatment interventions (inotropes, ventilation, fluid resuscitation), and outcomes (survival vs non-survival, length of stay) were recorded. Data were analyzed using descriptive and inferential statistics; multivariate analysis identified independent predictors of mortality. A p-value <0.05 was considered significant. Results: During the study period, n = 110 children fulfilled criteria for septic shock. The mean age was 4.8±3.2 years, with about 55% below 5 years. Male: female ratio was approximately 1.3:1. The most common presenting symptoms were fever (100%), lethargy (78%), breathlessness (65%), and vomiting (42%). Co-morbidities included malnutrition (35%), anemia (40%), and prior recurrent infections (25%). Pneumonia was the most frequent source of infection (45%), followed by gastrointestinal infections (20%), CNS infections (15%), and others. Laboratory findings included leukocytosis (60%), thrombocytopenia (30%), elevated creatinine (25%), raised liver enzymes (20%), and positive blood cultures in 35%, with Pseudomonas, Staphylococcus aureus, and Escherichia coli as major isolates. Over 70% had multi-organ dysfunction (MODS). Interventions: fluid resuscitation in all, inotropes in 65%, mechanical ventilation in 40%. The overall mortality was 38%. Non-survivors had higher pSOFA scores (>10), MODS, multiple inotropes, delayed presentation (>48 hours), malnutrition, and need for mechanical ventilation (all p<0.05). Mean hospital stay among survivors was 8.2±4.5 days.

Conclusion: Pediatric septic shock at GMC Srinagar is associated with high morbidity and mortality. Younger age (<5 years), MODS, high pSOFA score, malnutrition, delayed presentation, and requirement for mechanical ventilation and multiple inotropes are significant predictors of poor outcome. Early recognition, aggressive monitoring, protocol-based treatment, and improvements in supportive care are essential to improve survival.