{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:11:30Z","timestamp":1790143890399,"version":"4.0.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sepsis causes significant pediatric hospitalizations and deaths globally. The impact of supportive care interventions remains under-studied in sub-Saharan Africa, where mortality is greatest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective cohort study of children under five years hospitalized with study-defined suspected invasive bacterial infection and \u22652 adapted systemic inflammatory response syndrome (SIRS) criteria at l'H\u00f4pital Gabriel Tour\u00e9 (HGT), a tertiary care center in Bamako, Mali, between January 2021 and July 2024. Associations between supportive care therapies (antibiotics, intravenous fluids, and supplemental oxygen) and in-hospital mortality were evaluated using multivariable logistic regression and time-varying Cox proportional hazards models adjusted for prespecified demographic and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,569 enrolled children, 165 (10.5%) had a culture positive for a putative pathogen; 516 (32.9%) died during hospitalization. Most patients received antibiotics (86.4%), while 56.0% received intravenous fluids and 28.7% received supplemental oxygen. Antibiotics and intravenous fluids were not significantly associated with mortality after adjustment. Receipt of supplemental oxygen was associated with higher odds of in-hospital death (aOR: 2.09, 95% CI: 1.50, 2.91), an association potentially reflecting confounding by indication due to greater illness severity among children receiving oxygen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this observational cohort with high in-hospital mortality from suspected pediatric sepsis, supportive care therapies were not associated with improved survival after multivariable adjustment. These findings may reflect confounding by indication and a high burden of antimicrobial resistance that may limit the effectiveness of empiric antibiotic therapy. Reducing pediatric sepsis mortality in resource-limited settings will require improved access to microbiologically active antibiotics alongside context-appropriate pediatric critical care interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1924848","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:50:29Z","timestamp":1790142629000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Supportive care and in-hospital mortality among children with suspected sepsis in Bamako, Mali"],"prefix":"10.3389","volume":"14","author":[{"given":"William L.","family":"Still","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland Baltimore","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adama 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