Most children with septic shock are not receiving appropriate life-saving treatment in A&E, a UK audit suggests.
The six-month study found gold-standard therapy with fluid replacement and drugs to boost heart activity was not used in 62% of cases.
There is scope to significantly improve survival chances for the 1,000 children admitted with sepsis every year, the researchers said.
The findings appear in Archives of Diseases in Childhood.
Septic shock is a catastrophic immune system reaction to infection which produces organ failure.
"Every trust needs to look at their own performance on the back of this study and make sure they are meeting agreed standards"
Up to 20% of children admitted to paediatric intensive care with severe sepsis die.
The audit was done in 200 children admitted to 17 paediatric intensive care units across the UK in the first half of 2007.
According to best practice advice from the American College of Critical Care, generous fluid replacement should be given to boost blood volume, and inotropic drugs used to increase blood pressure.
But the study found that this was only done in 38% of cases.
The researchers said 17% of children in the study died, which was higher than they expected but not statistically significant.
Survival
Dr David Inwald, clinical senior lecturer in paediatric intensive care at Imperial College and study leader, said it was the first time the issue had been looked at systematically in the UK.
"We know that children who present in shock because of infection aggressive fluid resuscitation can improve survival.
"It was a surprise that the guidelines weren't followed in so many children."
He added they did not know why the guidelines were apparently being ignored.
"We now need to look more carefully at what's happening in A&E departments - there definitely seems to be a problem."
Dr Martin Shalley, ex-president of the British Association of Emergency Medicine, and A&E consultant at Birmingham Heartlands Hospital pointed out that severe sepsis in children was rare.
"This is one of the underpinning treatments and so we need to look at it and improve our performance.
"Every trust needs to look at their own performance on the back of this study and make sure they are meeting agreed standards."
Dr Don MacKechnie, clinical vice-president of the College of Emergency Medicine said: "There are guidelines and if they aren't being followed we need to look at why that is."
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