Fuller D1, Hussey A1
1Starship Child Health, PICU
Biography:
Dr Alex Hussey, Paediatric Intensivist, Starship Child Health. Medical Lead for PICU Transport, Paediatric ECMO/VAD and Research.
Miss Di Fuller, Clinical Nurse Specialist – Transport, PICU, Starship Child Health.
Abstract
Background
Sepsis remains a leading cause of paediatric mortality worldwide. In New Zealand, children with fulminant sepsis frequently require interhospital retrieval to a single quaternary PICU, creating unique clinical and logistical challenges. Adjuncts such as methylene blue are increasingly used in refractory vasoplegic shock, though paediatric evidence is limited.
Objectives
To describe New Zealand’s experience of paediatric fulminant sepsis, including epidemiology, microbiology, retrieval characteristics, and use of advanced and adjunctive therapies.
Methods
We conducted a retrospective observational review of children with fulminant sepsis requiring retrieval to Starship Children’s Hospital PICU across pre- and post-COVID-19 epochs. Data included demographics, ethnicity, referral patterns, causative organisms, illness severity, therapies (including vasoactive support, methylene blue, and extracorporeal membrane oxygenation [ECMO]), and outcomes. Retrieval timelines and key interventions were analysed. Two cases illustrate operational challenges.
Results
Fulminant sepsis requiring retrieval represents a high-acuity cohort with significant resource utilisation. Post-pandemic shifts in epidemiology were observed. Invasive bacterial infections, particularly streptococcal species, predominated. A subset developed refractory shock; methylene blue was used as a rescue therapy. ECMO was required in selected cases. Retrieval over long distances in unstable patients posed challenges in stabilisation and escalation of care. Ethnic disparities in disease burden and access to care were evident.
Conclusions
Paediatric fulminant sepsis in New Zealand remains associated with high morbidity and complex retrieval demands. Methylene blue may have a role in refractory vasoplegia, but evidence is limited. Optimising early recognition, equitable access, and retrieval systems is essential to improve outcomes.