{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:04:34Z","timestamp":1791813874795,"version":"4.3.4"},"reference-count":127,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14092983","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:42:09Z","timestamp":1745577729000},"page":"2983","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Immunomodulation in Pediatric Sepsis: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2723-9914","authenticated-orcid":false,"given":"Gabriella","family":"Bottari","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Children Hospital Bambino Ges\u00f9, IRCSS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB), 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Corrias","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, \u201cMicrocitemico\u2014A. Cao\u201d Pediatric Hospital, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Irrera","sequence":"additional","affiliation":[{"name":"Academy of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Currao","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, \u201cMicrocitemico\u2014A. Cao\u201d Pediatric Hospital, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8415-4247","authenticated-orcid":false,"given":"Michele","family":"Salvagno","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB), 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Cecchetti","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Children Hospital Bambino Ges\u00f9, IRCSS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2926-5328","authenticated-orcid":false,"given":"Didier","family":"Payen","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9 Sorbonne, 75006 Paris, France"},{"name":"Recherche Service Maladies Infectieuses, CHU de Nice, 06200 Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e10128","DOI":"10.15252\/emmm.201810128","article-title":"Sepsis therapies: Learning from 30 years of failure of translational research to propose new leads","volume":"12","author":"Cavaillon","year":"2020","journal-title":"EMBO Mol. 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