Designing Sepsis Care Around Children: UCSF Pediatrician Helps Shape Global Framework

Sepsis – the body’s life-threatening response to infection – accounts for one in five deaths worldwide. Children bear a disproportionate share of that burden, particularly in low-resource settings, where infections like pneumonia, diarrheal disease, and malaria can quickly become fatal.

Teresa Kortz, MD, MS, PhD, associate professor in the Division of Pediatric Critical Care at UCSF, is leading a global approach to reducing these deaths where children are most at risk.

As a member of a Task Force convened by the Society of Critical Care Medicine (SCCM), Kortz was first author on a consensus framework, “10 Steps to Improve Sepsis Care in Low-Resource Settings,” published in Critical Care Medicine. The paper provides a practical roadmap for strengthening sepsis care across the full continuum, from prevention and early recognition to post-discharge recovery.

Built from the Bedside

Kortz’s perspective is grounded in years of NIH-funded research on pediatric sepsis in East Africa, where she studies disease etiology, risk stratification, and clinical outcomes in low-resource settings. That frontline work identifies which interventions most effectively improve children's survival.

“In past studies, we saw that children often presented late, diagnostics were limited, and even basic interventions like timely antibiotics or oxygen were inconsistently available,” she says. “Delays before reaching care were often as critical as what happened in the hospital.”

For children, these gaps point to a challenge beyond clinical decision-making. When recognition depends on caregivers, access to care is delayed, and tools are limited, outcomes are often shaped by how well systems support early detection and rapid response.

Those observations helped shift the framework beyond hospital-based guidelines toward systems that reflect how children actually experience illness – emphasizing caregiver education, triage and referral pathways, and continuity of care.

Low-Tech, High-Impact Care

Many of the framework’s most impactful steps focus on simple interventions. Children’s health can deteriorate quickly from sepsis, making caregiver and frontline provider training around World Health Organization (WHO) “danger signs” essential.

Prevention through vaccination, nutrition, and sanitation can keep children from needing hospital care in the first place. And timely access to essential treatments like oxygen, fluids, and antibiotics remains one of the most powerful ways to save lives.

“What’s striking is that many of these are low-technology, high-impact interventions,” Kortz says. “They don’t require advanced ICU-level care, but they do require coordinated systems.”

Kortz’s research also highlighted a less visible risk: for many children, survival to discharge is not the end of the illness. Post-discharge mortality remains high in low-resource settings, and many children experience long-term complications. The framework’s inclusion of structured follow-up reflects the importance of assisting recovery beyond the hospital.

From Framework to Implementation

Evidence from Kortz’s global research demonstrates the potential impact of the framework’s approach. In the Global PARITY study, which Kortz led across 19 countries, the team found that pediatric critical illness in low-resource settings is highly treatable, with many deaths occurring within the first 48 hours. Crucially, these children could have benefited from basic interventions and earlier recognition, highlighting how strengthening systems to deliver essential care can have an outsized impact on survival.

UCSF is already helping move this work forward. Kortz and Abigail Sorensen, MD, a pediatric critical care fellow at UCSF, are partnering with institutions in East Africa to evaluate pediatric sepsis protocols. The team is also developing point-of-care diagnostic tools and training future global health clinicians through programs including the GloCal and CHESA fellowships at UCSF. Through the UCSF-WHO Collaborating Center, the 10-step framework is being integrated into existing health systems.

“Where a child is born should not determine whether they survive sepsis,” Kortz says. “The 10-step framework represents a shift toward actionable, scalable solutions that can be adapted to local contexts.”

By centering care around how children experience illness – from home to recovery – this global framework aims to close the gap between what is known to save children’s lives and what is possible in practice.

This work reflects the UCSF Division of Pediatric Critical Care’s commitment to advancing equitable, high-impact care for critically ill children.