 Septic shock is defined as children who have a suspected infection manifested by hypothermia or hyperthermia and have at least two clinical signs of decreased perfusion with or without hypotension such as decreased mental status, prolonged capillary refill of 2 secs cold shock or flash capillary refill warm shock, diminished cold shock or bounding warm shock peripheral pulses, mottled cool extremities cold shock, or decreased urine output of 1 mlkghr. 