Suspected Sepsis Clinical Pathway — N/IICU | Children's Hospital of Philadelphia

N/IICU Newborns and Infants > 72 hrs of Age
at Risk for Bacterial Infection

RN Evaluates for Signs/Symptoms
Concerning for Infection

RN Notifies FLOC and Requests Bedside Huddle

RN, FLOC, +/- Attending or Fellow Huddle to Evaluate Signs/Symptoms Concerning for Sepsis
- VS trends
- Ins and outs
- Labs within last 24-48 hrs
- High-risk Conditions
- Congenital Heart Disease

Green Zone Low Suspicion for Invasive Infection
Evaluation	Consider Screening Labs
Treatment	Consider obtaining cultures and antibiotic initiation based on exam and clinical status

Yellow Zone Suspected Infection, No Shock
Evaluation	Obtain sepsis cart Cultures and Labs IV/IO Access
Treatment	Yellow Zone Antibiotics Administer ASAP
Reassessment	RN and FLOC reassess every 30-60 min

Red Zone Septic Shock or Sepsis-associated Organ Dysfunction
Evaluation	Obtain sepsis cart Cultures and Labs IV/IO Access
Treatment	Red Zone Antibiotics Administer ASAP Rapid Fluid Resuscitation NS 10-20 mL/kg bolus over 10-15 min
Reassessment	RN and FLOC reassess every 30-60 min

Clinical Goals Met

Monitor Response and VS Trends

Fluid Resuscitation

Steroids

Vasopressors

Management of Refractory Shock

Posted: September 2018
Revised: May 2025

Authors:
- S. Coggins, MD;
- L. Srinivasan, MBBS;
- S. Gattoline, PharmD;
- K. Bordner, MPAS;
- K. Gibbs, MD;
- M. Harris, MD;
- K. Chiotos, MD;
- T. Metjian, PharmD;
- D. Munson, MD;
- M. Padula, MD

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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N/IICU Clinical Pathway for Evaluation and Treatment
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Suspected Sepsis Clinical Pathway — N/IICU

N/IICU Clinical Pathway for Evaluation and Treatmentof Suspected Sepsis in Newborns and Infants

Evidence

N/IICU Clinical Pathway for Evaluation and Treatment
of Suspected Sepsis in Newborns and Infants