ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ ĐIỀU TRỊ TRẺ SỐC NHIỄM TRÙNG TẠI BỆNH VIỆN NHI ĐỒNG ĐỒNG NAI

Abstract

Background: Septic shock (SS) is a common pediatric emergency with a high mortality rate if not promptly recognized and managed. Dong Nai Children’s Hospital is a provincial-level pediatric specialty hospital with limited critical care resources. This study aims to describe the clinical and laboratory characteristics as well as the treatment approaches in children with septic shock at Dong Nai Children’s Hospital, and to evaluate treatment outcomes based on the Phoenix 2025 diagnostic criteria. Methods: A cross-sectional descriptive study was conducted from February 1, 2024 to August 30, 2025, involving 50 children aged from 1 month to 16 years who were diagnosed with septic shock according to the Phoenix criteria. Data were collected retrospectively from medical records and analyzed using Stata 12.0 software. Results: Among the 50 pediatric patients with septic shock, 29 were male (58%) and 18 (36%) were under 2 years old. Of these, 32% (16 patients) had underlying conditions such as Down syndrome, cerebral palsy, or congenital heart disease. The most common site of infection was the gastrointestinal tract (50%), followed by the respiratory tract (26%). Common clinical signs included cold extremities and prolonged capillary refill time (both observed in 90%), and altered consciousness was present in 52% of cases. Severe laboratory abnormalities included thrombocytopenia (platelets < 100 x 10⁹/L) in 24% of patients and procalcitonin levels ≥ 99 ng/mL in 40%. Metabolic acidosis was reflected by pH < 7.2 in 52%, HCO₃⁻ < 15 mmol/L in 76%, and blood lactate ≥ 5 mmol/L in 48% of patients. Organ dysfunction rates were hepatic dysfunction in 16%, acute kidney injury in 25%, and myocardial injury with positive troponin in 30.8%. The most common isolated pathogens were Staphylococcus aureus, Escherichia coli, and Streptococcus pneumoniae. In terms of treatment, 88% of patients required mechanical ventilation, 90% received noradrenaline, 72% received adrenaline, and 44% underwent blood purification. Despite intensive interventions, the in-hospital mortality rate was 32%. Conclusion: Children with septic shock admitted to Dong Nai Children’s Hospital often presented in severe clinical condition. The mortality rate remains high. Early recognition, safe referral, and intensive treatment are key factors in improving patient outcomes.