One in ten children with suspected sepsis received corticosteroids

Design

Multicentre prospective observational cohort

Population

5119 children with suspected sepsis, 11 EDs in Australia and New Zealand

Primary outcome

Corticosteroid use within 24 hours of admission

Effect

9.6% overall; 31.3% of those meeting Phoenix criteria; 70% dexamethasone

This prospective observational study across 11 emergency departments in Australia and New Zealand followed 5119 children with suspected sepsis admitted between 2021 and 2023, median age 1.6 years. Published in Archives of Disease in Childhood on 29 September 2026.

Corticosteroids were given within 24 hours to 9.6% of all children and 31% of those meeting the Phoenix sepsis criteria. Dexamethasone accounted for 70% and hydrocortisone for 25%, with wide variation between sites. Use was associated with older age, comorbidities, raised lactate, large fluid volumes and vasopressors. Most use was outside fluid- or catecholamine-refractory shock.

The evidence for steroids in paediatric sepsis is thin and mainly supports hydrocortisone in refractory shock. Much of the dexamethasone use may reflect other indications such as croup, asthma or meningitis, which this study could not fully separate.

This describes practice, not outcomes, so it cannot say whether the steroids helped or harmed.

• Reserve hydrocortisone in sepsis for fluid- and catecholamine-refractory shock
• Record the indication whenever a steroid is given to a child with sepsis
• Remember that dexamethasone has its own indications, such as bacterial meningitis and croup
• Follow local sepsis guidelines until trial evidence changes them

Why it matters

Steroid use in paediatric sepsis is common and varies by hospital, which shows how little evidence guides it.

Don't overread it

This observational study describes use; it says nothing about whether steroids changed outcomes.

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