Bottari Gabriella, Taccone Fabio Silvio, Corrias Angelica, Irrera Mariangela, Currao Paolo, Salvagno Michele, Cecchetti Corrado, Payen Didier
Pediatric Intensive Care Unit, Children Hospital Bambino Gesù, IRCSS, 00165 Rome, Italy.
Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium.
J Clin Med. 2025 Apr 25;14(9):2983. doi: 10.3390/jcm14092983.
Pediatric sepsis presents a unique clinical challenge due to the distinct characteristics of the developing immune system. The immune response in children differs significantly from that in adults, exhibiting a unique combination of resistance, disease tolerance, and resilience. These factors influence the clinical presentation and prognosis of pediatric patients with sepsis. Over the past few years, various studies have explored the role of immunomodulatory therapies in managing sepsis, including the use of immunoglobulins, corticosteroids, monoclonal antibodies, and immunostimulatory treatments. However, the heterogeneity of the clinical presentations and individual responses makes it difficult to identify universally effective treatments. Recent research has highlighted the importance of a personalized approach based on specific biomarkers and patient phenotyping. Extracorporeal blood purification techniques have emerged as promising strategies for the modulation of hyperinflammation. However, strong evidence supporting their routine use in pediatric sepsis is lacking. This review provides a comprehensive overview of the current knowledge of the immune response in pediatric sepsis and discusses the main immunomodulatory strategies and future perspectives for personalized therapy. A deeper understanding of the immunological differences between children and adults could improve the prognosis and treatment efficacy, paving the way for new approaches to pediatric sepsis management.
由于发育中的免疫系统具有独特的特征，小儿脓毒症呈现出独特的临床挑战。儿童的免疫反应与成人有显著差异，表现出抵抗力、疾病耐受性和恢复力的独特组合。这些因素影响着小儿脓毒症患者的临床表现和预后。在过去几年中，各种研究探讨了免疫调节疗法在脓毒症管理中的作用，包括使用免疫球蛋白、皮质类固醇、单克隆抗体和免疫刺激治疗。然而，临床表现和个体反应的异质性使得难以确定普遍有效的治疗方法。最近的研究强调了基于特定生物标志物和患者表型分析的个性化方法的重要性。体外血液净化技术已成为调节过度炎症反应的有前景的策略。然而，缺乏支持其在小儿脓毒症中常规使用的有力证据。本综述全面概述了目前关于小儿脓毒症免疫反应的知识，并讨论了主要的免疫调节策略和个性化治疗的未来前景。对儿童和成人之间免疫差异的更深入理解可以改善预后和治疗效果，为小儿脓毒症管理的新方法铺平道路。
