| CARDIOVASCULAR DYSFUNCTION |
- Despite administration of isotonic intravenous fluid bolus ≥40 mL/kg in 1 hr
|
- Decrease in BP (hypotension) <5th percentile for age or systolic BP <2 SD below normal for age
|
| OR |
- Need for vasoactive drug to maintain BP in normal range (dopamine >5 g/kg/min or dobutamine, epinephrine, or norepinephrine at any dose)
|
| OR |
| Two of the following: |
- Unexplained metabolic acidosis: base deficit >5.0 mEq/L
|
- Increased arterial lactate >2 × upper limit of normal
|
- Oliguria:urine output <0.5 mL/kg/hr
|
- Prolonged capillary refill: >5 sec
|
- Core to peripheral temperature gap >3° C
|
| RESPIRATORY |
- Pao2/Fio2 <300 in absence of cyanotic heart disease or pre-existing lung disease
|
| OR |
- PaCO2 >65 torr or 20 mm Hg over baseline PaCO2
|
| OR |
- Proven need or >50% Fio2 to maintain saturation ≥92%
|
| OR |
- Need for nonelective invasive or noninvasive mechanical ventilation
|
| NEUROLOGIC |
|
|
| OR |
- Acute change in mental status with a decrease in Glasgow Coma score ≥3 points from abnormal baseline
|
| HEMATOLOGIC |
- Platelet count <80,000/mm3 or a decline of 50% in the platelet count from the highest value recorded over the last 3 days (for patients with chronic hematologic or oncologic disorders)
|
| OR |
- International normalized ratio >2
|
| RENAL |
- Serum creatinine ≥2 × upper limit of normal for age or 2-fold increase in baseline creatinine
|
| HEPATIC |
- Total bilirubin ≥4 mg/dL (not applicable for newborn)
|
- Alanine transaminase level 2 × upper limit of normal for age
|