Version July 2025
| Variables | 0 points | 1 point | 2 points | 3 points | |
| Respiratory, 0 to 3 points | |||||
| PaO2:FIO2 ≥400 or SpO2:FIO2 ≥292¶ | PaO2:FIO2 <400 on any respiratory support or SpO2:FIO2 <292 on any respiratory support¶Δ | PaO2:FIO2 100 to 200 and IMV or SpO2:FIO2 148 to 220 and IMV¶ | PaO2:FIO2 <100 and IMV or SpO2:FIO2 <148 and IMV¶ | ||
| Cardiovascular, 0 to 6 points | |||||
| 1 point each (up to 3) | 2 points each (up to 6) | ||||
| No vasoactive medications◊ | 1 vasoactive medication◊ | ≥2 vasoactive medications◊ | |||
| Lactate <5 mmol/L§ | Lactate 5 to 10.9 mmol/L§ | Lactate ≥11 mmol/L§ | |||
| Age based¥ | |||||
| Mean arterial pressure, mmHg‡ | |||||
| <1 month | >30 | 17 to 30 | <17 | ||
| 1 to 11 months | >38 | 25 to 38 | <25 | ||
| 1 to <2 years | >43 | 31 to 43 | <31 | ||
| 2 to <5 years | >44 | 32 to 44 | <32 | ||
| 5 to <12 years | >48 | 36 to 48 | <36 | ||
| 12 to 17 years | >51 | 38 to 51 | <38 | ||
| Coagulation (0 to 2 points)† | |||||
| 1 point each (maximum 2 points) | |||||
| Platelets ≥100 × 103/μL | Platelets <100 × 103/μL | ||||
| International normalized ratio ≤1.3 | International normalized ratio >1.3 | ||||
| D-dimer ≤2 mg/L FEU | D-dimer >2 mg/L FEU | ||||
| Fibrinogen ≥100 mg/dL | Fibrinogen <100 mg/dL | ||||
| Neurological (0 to 2 points)** | |||||
| Glasgow Coma Scale score >10; pupils reactive¶¶ | Glasgow Coma Scale score ≤10¶¶ | Fixed pupils bilaterally | |||
| Phoenix sepsis criteria | |||||
| Sepsis | Suspected infection and Phoenix Sepsis Score ≥2 points | ||||
| Septic shock | Sepsis with ≥1 cardiovascular point(s) | ||||
FEU: fibrinogen equivalent units; IMV: invasive mechanical ventilation; INR: international normalized ratio of prothrombin time; MAP: mean arterial pressure; PaO2:FIO2: arterial partial pressure of oxygen to fraction of inspired oxygen ratio; SpO2: oxygen saturation measured by pulse oximetry (only SpO2 of ≤97%).
* The score may be calculated in the absence of some variables (eg, even if lactate level is not measured and vasoactive medications are not used, a cardiovascular score can still be ascertained using blood pressure). It is expected that laboratory tests and other measurements will be obtained at the discretion of the medical team based on clinical judgment. Unmeasured variables contribute no points to the score. Ages are not adjusted for prematurity, and the criteria do not apply to birth hospitalizations, neonates whose postconceptional age is younger than 37 weeks, or those 18 years of age or older.
¶ SpO2:FIO2 ratio is only calculated if SpO2 is 97% or less.
Δ The respiratory dysfunction of 1 point can be assessed in any patient receiving oxygen, high-flow, noninvasive positive pressure, or IMV respiratory support, and includes a PaO2:FIO2 ratio of less than 200 and a SpO2:FIO2 ratio of less than 220 in children who are not receiving IMV. For children receiving IMV with a PaO2:FIO2 less than 200 and SpO2:FIO2 less than 220, refer to criteria for 2 and 3 points.
◊ Vasoactive medications include any dose of epinephrine, norepinephrine, dopamine, dobutamine, milrinone, and/or vasopressin (for shock).
§ Lactate reference range is 0.5 to 2.2 mmol/L. Lactate can be arterial or venous.
¥ Age is not adjusted for prematurity, and the criteria do not apply to birth hospitalizations, children whose postconceptional age is younger than 37 weeks, or those 18 years or older.
‡ Use measured MAP preferentially (invasive arterial if available or noninvasive oscillometric), and if measured MAP is not available, a calculated MAP (1/3 × systolic + 2/3 × diastolic) may be used as an alternative.
† Coagulation variable reference ranges: platelets, 150 to 450 × 103/μL; D-dimer, <0.5 mg/L FEU; fibrinogen, 180 to 410 mg/dL. The INR reference range is based on the local reference prothrombin time.
** The neurological dysfunction subscore was pragmatically validated in both sedated and nonsedated patients, and those receiving or not receiving IMV support.
¶¶ The Glasgow Coma Scale score measures level of consciousness based on verbal, eye, and motor response (range, 3 to 15, with a higher score indicating better neurological function).