Sepsis-associated neurologic dysfunction

Sepsis is a leading cause of morbidity and mortality for infants and children in the United States and is associated with peripheral and central nervous system dysfunction including encephalopathy and paresis. Sepsis-associated encephalopathy (SAE) may be underdiagnosed in children, but the exact incidence is not known because of variable criteria for its diagnosis, which require a high index of suspicion and exclusion of other confounding factors. Neuroimaging and cerebrospinal fluid analysis are often normal. Electroencephalography may correlate with the severity of encephalopathy. Intensive care unit-acquired weakness due to critical illness neuropathy or myopathy develops later, and resolution of weakness is gradual. Difficulty weaning from the ventilator is an early sign. Electroencephalography may be helpful in identifying SAE once other causes of encephalopathy have been ruled out. However, the lack of consensus on the definition of SAE and sparse pediatric data limit the specific evidence-based recommendations, which can be made for the assessment and treatment of this disorder in the emergency department.