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Volume 14
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10.3390/jcm14092983
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Immunomodulation in Pediatric Sepsis: A Narrative Review

by
Gabriella Bottari
1,*,
Fabio Silvio Taccone
2,
Angelica Corrias
3,
Mariangela Irrera
4,
Paolo Currao
3,
Michele Salvagno
2,
Corrado Cecchetti
1 and
Didier Payen
5,6
1
Pediatric Intensive Care Unit, Children Hospital Bambino Gesù, IRCSS, 00165 Rome, Italy
2
Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
3
Pediatric Clinic, “Microcitemico—A. Cao” Pediatric Hospital, University of Cagliari, 09124 Cagliari, Italy
4
Academy of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
5
Université Paris Cité Sorbonne, 75006 Paris, France
6
Recherche Service Maladies Infectieuses, CHU de Nice, 06200 Nice, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(9), 2983; https://doi.org/10.3390/jcm14092983
Submission received: 9 March 2025 / Revised: 16 April 2025 / Accepted: 21 April 2025 / Published: 25 April 2025
(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)
Versions Notes

Abstract

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.
Keywords: pediatric septic shock; immune modulation; cytokine storm; multiple-organ dysfunction syndrome; immune dysfunction; immune paralysis pediatric septic shock; immune modulation; cytokine storm; multiple-organ dysfunction syndrome; immune dysfunction; immune paralysis

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MDPI and ACS Style

Bottari, G.; Taccone, F.S.; Corrias, A.; Irrera, M.; Currao, P.; Salvagno, M.; Cecchetti, C.; Payen, D. Immunomodulation in Pediatric Sepsis: A Narrative Review. J. Clin. Med. 2025, 14, 2983. https://doi.org/10.3390/jcm14092983

AMA Style

Bottari G, Taccone FS, Corrias A, Irrera M, Currao P, Salvagno M, Cecchetti C, Payen D. Immunomodulation in Pediatric Sepsis: A Narrative Review. Journal of Clinical Medicine. 2025; 14(9):2983. https://doi.org/10.3390/jcm14092983

Chicago/Turabian Style

Bottari, Gabriella, Fabio Silvio Taccone, Angelica Corrias, Mariangela Irrera, Paolo Currao, Michele Salvagno, Corrado Cecchetti, and Didier Payen. 2025. "Immunomodulation in Pediatric Sepsis: A Narrative Review" Journal of Clinical Medicine 14, no. 9: 2983. https://doi.org/10.3390/jcm14092983

APA Style

Bottari, G., Taccone, F. S., Corrias, A., Irrera, M., Currao, P., Salvagno, M., Cecchetti, C., & Payen, D. (2025). Immunomodulation in Pediatric Sepsis: A Narrative Review. Journal of Clinical Medicine, 14(9), 2983. https://doi.org/10.3390/jcm14092983

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