Web chat: Dr Simon Nadel answers your questions about sepsis

Dr Simon Nadel, clinical lead at the paediatric intensive care unit (PICU) at St Mary's Hospital.

Please join us for a web chat with Dr Simon Nadel, consultant in children's intensive care at St Mary's Hospital. On Thursday 4 February at 11.00, Dr Nadel will spend an hour right here, answering your questions about sepsis in children. Patients, GPs, other health workers and the public are all invited to submit questions about sepsis, including: 

  • What is sepsis?
  • What causes sepsis?
  • What are the symptoms of sepsis?
  • How is sepsis treated?

You can submit your web chat questions from 10.00 on Thursday, 4 February. You can also follow the chat or submit questions in advance through our Twitter channel @imperialnhs. If you can't make to the live chat, you can check our website later to see the chat in full. 

Dr Nadel has worked in the field of intensive care for over 24 years having completed his training in paediatric infectious diseases at the Children’s Hospital of Philadelphia, and paediatric intensive care training at Great Ormond Street Hospital before joining St Mary’s Hospital in 1994. He is the clinical lead in the children's intensive care unit and was recently appointed the adjunct professor at Imperial College. As a trustee of COSMIC (Children of St Mary's Intensive Care), Dr Nadel is one of the leaders of the Live Blog Ask Dr Simon Nadel about sepsis.

Comment From Jo 
We see so much about temperatures being the first sign of something wrong and i give my child calpol when he has a temperature but when should I seek medical attention - at what point does the temperature become dangerous and possibly something like sepsis?
Dr Simon Nadel: 
Temperature in itself isn't harmful. In fact, some very severe infections may be associated with a low temperature. It's the other signs and symptoms of infection that would be more worrying that sepsis is developing. 

Dr Simon Nadel: 
Sepsis is the body’s response to an infection. It is usually recognised by fever, muscle aches, shivering, fast heart rate, vomiting or diarrhoea. It can be caused by any type of infection including viruses, bacteria and fungi. In the early stages of sepsis, the symptoms can be very nonspecific, but as it progresses, if it is not treated appropriately, it can cause organ failure, shock and death. 

Some infections have specific features that help to make the diagnosis earlier, such as: meningococcal septicaemia, which typically presents with a rash that does not blanch on pressure. 

Risks are much higher in young children – less than a year old – and the elderly. Other conditions that may be associated with an increased risk are anything that suppresses your immunity, such as steroid treatment, treatment for cancer, having just had surgery or a serious accident, childbirth, or some other chronic medical condition like diabetes. 

Another important symptom is change in behaviour. In children, this could include being sleepy, drowsy or very lethargic. In older people, it would include not behaving like their normal selves – even subtle changes in the behaviour of the elderly, including being unusually forgetful or confused, could indicate a problem like sepsis. 
Comment From Anon 
What should I look out for? How are the symptoms different to meningitis?
Dr Simon Nadel: 
Meningitis is an infection of the membranes around the brain. It is usually associated with fever, headache, neck stiffness and symptoms may progress to sleepiness and in advanced cases, coma. 

Sepsis symptoms typically include fever, muscle aches, headaches, vomiting, diarrhoea. Some of these symptoms are also seen in meningitis, as often in bacterial meningitis there is also infection in the bloodstream. 

In either case, if symptoms persist or get worse, or you are concerned, you should seek urgent medical advice.
Comment From Jayne 
Are there any long term side effects after having sepsis?
Dr Simon Nadel: 
It is difficult to say. It depends on the severity of the sepsis and what kind of sepsis you have. If sepsis is recognised quickly and treated appropriately, the outcome is very good with no obvious long-term effects. 

However, in more severe forms of sepsis - associated with organ failure - there may be significant long-term effects.
Comment From Michael 
does meningitis lead to sepsis?
Dr Simon Nadel: 
Yes, it can. Sepsis is a general term. It is the body's response to an infection. 

Meningitis is a specific form of sepsis. It is an infection of the membranes around the brain which is associated with fever, headache, neck stiffness and symptoms may progress to sleepiness and in advanced cases, coma.
Comment From Guest 
My daughter, now 14 months, had sepsis when she was born, she was in intensive care for a week. Is she more at risk of getting it again or getting meningitis B. As men B is a sepsis disease?
Comment From Levente 
If your child is having sepsis will they be ill when they are older?
Dr Simon Nadel: 
Young children are at higher risk of developing sepsis because they have an immature immune system. Just because they've had sepsis previously, it doesn't mean they are at increased risk of developing it again unless they've been found to have a problem with their immunity. In any case, it is really important to make sure that they have received all the immunisations that are recommended, as these vaccines have been proven to reduce the risk of sepsis.
Comment From Alison Hargreaves 
As a mother I'm slightly confused as to what sepsis is? I know it's a reaction to infection, but what exactly does that mean? Is it a virus etc?
Comment From Sian Naftal 
My daughter has the immune issue mannose binding lectin deficiency, does this make her more susceptible to sepsis, is there anything that we can do to stop it, she is on antibiotics for the winter will this help stop virus's from developing into sepsis?
Dr Simon Nadel: 
Sepsis is not in itself an infection - viral, bacterial or otherwise. It is how your body responds to an infection with the symptoms such as fever, shivering, muscle aches, headaches, vomiting and diarrhoea. Typically, minor infections are associated with mild symptoms that only last less than a few days. If symptoms persist for longer or get more severe, you should seek urgent medical advice.
Comment From Guest 
If you get Sepsis while pregnant, can if effect the unborn baby?
Dr Simon Nadel: 
Most infections women get while pregnant do not affect their unborn baby. Pregnant women are at increased risk of catching infections during pregnancy, so if they develop any symptoms of infection, they should seek urgent medical advice so they get treatment quickly. 

However, if sepsis is very severe, causing organ failure, then this may have effects on the unborn baby. Also, some infections such as some viral infections may cross the placenta and have effects on the unborn baby, particularly in the early phase of pregnancy. 

Newborn babies may develop sepsis due to infections that they catch during delivery. However, this is rare and usually associated with signs of sepsis in the mother at the time of delivery. 

Dr Simon Nadel: 
A lady wrote in about her daughter having deficiency of Mannan Binding Lectin. This is a protein which is important in protecting children from infections, and may be associated of an increased risk, particularly of bacterial infections. Your daughter is on antibiotics to help prevent bacterial infections, as antibiotics are not effective against viruses. As children get older it is likely that they develop better defence against infections. For more specific advice you should discuss with the doctors who diagnosed your daughter.
Comment From Fiona 
Would getting the meningitis B vaccine help reduce the risk? Are there any side of effects?
Dr Simon Nadel: 
Meningitis B is now the most common cause of bacterial meningitis and septicaemia in young children. The meningitis B vaccine has been shown to be effective in reducing the risk of catching meningitis B and therefore, reducing the risk of sepsis.

The vaccine may cause high fever with the first or second dose, so it is recommended that paracetamol be given at the same time as the vaccine to reduce the fever.
Comment From Guest 
I am new to this website and am new to working for the trust, nhs etc. just wanted to say this is a great tool and I have just read through the earlier comments which have been very interesting and beneficial so thank you!
Dr Simon Nadel: 
Thank you for your kind comment! I'm delighted to be here to answer your questions, and I am glad you find this helpful.
Comment From Rina 
Are children more affected by sepsis than adults? Can you get it when you grow up?
Dr Simon Nadel: 
Risks are much higher in young children – less than a year old – and the elderly. Other conditions that may be associated with an increased risk are anything that supresses your immunity, such as steroid treatment, treatment for cancer, having just had surgery or a serious accident, childbirth, or some other chronic medical condition like diabetes. 

You can get sepsis at any age, but the risks are lower in older children and young adults, unless they have an underlying health problem such as those described above.
Comment From Jonas 
Comparison between how infection crosses the brain membrane in meningitis, at what point does any infection becomes sepsis in immune response or any specific failure in the immunity for sepsis to set in? not sure if I make sense!

Dr Simon Nadel: 
People with lower immunity are more at risk of developing sepsis. The distinction between an uncomplicated infection and sepsis is sometimes difficult to make, as some mild symptoms are common in all infections. Sepsis is suspected when someone at risk of infection develops symptoms that are out of proportion or different to what they normally experience with a simple infection. 

Sepsis is associated with a change in the function of the body's organs. Fast heart rate, cold hands and feet, confusion, and lower urine output are more specific signs of sepsis. If symptoms persist or get worse, then seek urgent medical advice. 

Comment From Guest 
Dr, what about Sepsis in Cancer Patients? what are the earliest symptoms to look out for and how fast to act?
Dr Simon Nadel: 
People being treated for cancer typically have lower immunity. As we said above, people with lower immunity are more at risk for sepsis. 

People being treated with medicines that suppress their immunity may not develop the classical symptoms of sepsis. Any unusual symptoms such as a new change in behaviour, unexplained fast heart rate, fast breathing, or muscle aches or headaches should prompt a patient to seek urgent medical attention.
Comment From D.Ramah 
Dear Dr, what about Cancer Patients? How early are the symptoms detected in Cancer patients, and what are they? How fast should patients be taken to hospital and what treatment to expect at hospital?
Dr Simon Nadel: 
We've just finished our answer to that question - please see the above answer! Again, symptoms like those described above should prompt a patient to seek urgent medical attention.
Comment From Shoid 
What short term help can you to to help patients before an ambulance can arrive.
Dr Simon Nadel: 
The most important factor in helping to improve outcome of severe sepsis is early recognition of the features of sepsis and seeking urgent medical advice. The earlier you call an ambulance or call for urgent medical help, the more likely it will be that sepsis will be treated quickly. There is nothing that can be done before the ambulance arrives - the most important thing is calling the ambulance or seeking urgent medical advice if sepsis is suspected.
Dr Simon Nadel: 
NICE is currently developing new guidelines for the recognition, diagnosis and management of severe sepsis, which should be released in July. I am one of the members of the guideline development group, and these guidelines will be publicly available.
Comment From Anon 
Is there any way to prevent my child getting sepsis?
Dr Simon Nadel: 
All children get recurrent mild infections, but most parents understand how these affect their children. Any symptoms that appear unusual or prolonged should prompt you to seek urgent medical advice.

In terms of prevention, the most effective method to prevent your child getting sepsis is to ensure that they have received all the recommended vaccines.
Dr Simon Nadel: 
In our children’s intensive care unit, the vast majority of children are admitted with an infection-related problem. That could include pneumonia, meningitis or blood poisoning. These specific infections all present in their early phases as sepsis as described earlier (symptoms could include fever, muscle aches, headaches, fast heart rate, fast breathing, vomiting or diarrhoea). 

We are involved in research to find out why some children are much more at risk of developing sepsis than others and to find out how to improve treatment to help improve their outcome.
Dr Simon Nadel: 
A woman wrote to us via email with this question: 'Following the birth of my child, my child and I both caught strep A, severe septic shock, which left me very ill and needing a kidney transplant. I also suffered nerve damage to my feet and hands. I am now recovering, but I am extremely worried about my son, who is now two and a half. I have no idea if he has nerve damage too. Can you provide any advice?'
Dr Simon Nadel: 
First, I am so sorry to hear that you have had such a difficult time. 

If your son doesn’t have any obvious nerve damage at this stage, it is unlikely that he will develop any. I’m not clear how severe his illness was, but if he is well now, he will not develop any other problems related to his illness then. Of course, if you are concerned about any long-term effects, it would be important to go back to the doctors who are following his development. 

Dr Simon Nadel: 
Thank you all so much for your time. I have to get back to my patients in the children's intensive care unit at St Mary's Hospital. As you may have heard, we are currently planning to refurbish and expand our unit so we can admit and treat more seriously ill children. If you would like to learn more about our appeal, please visit