Myocardial dysfunction during sepsis in children with cancer: a scoping review across paediatric cardio-oncology and critical care

BACKGROUND: Children with cancer may develop cardiac dysfunction during sepsis or severe infection due to prior cardiotoxic therapy, fluid exposure, systemic inflammation, and critical illness. We aimed to map evidence on myocardial dysfunction and related cardiac involvement during sepsis or severe infection in this population. METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library through June 2026. Eligible studies included pediatric patients with cancer or hematopoietic stem cell transplantation who developed sepsis, septic shock, febrile neutropenia, bacteremia, bloodstream infection, or invasive fungal infection and underwent cardiac or hemodynamic assessment. RESULTS: Of 874 records identified, 749 remained after deduplication and 11 studies were included. Evidence consisted mainly of observational studies, case reports, case series, and conference abstracts. Cardiac findings included acute systolic dysfunction, myocarditis-like presentations, elevated B-type natriuretic peptide, transient bradycardia, abnormalities in echocardiographic assessment of fluid responsiveness, and endocarditis. Children with leukemia, particularly those exposed to anthracyclines, were most frequently represented. Cardiac recovery was reported in several cases, although mortality was high when sepsis and progressive cardiac dysfunction coexisted. No study directly compared incidence between children with and without cancer. CONCLUSION: Cardiac involvement during sepsis in children with cancer is recognized but remains under-studied and inconsistently defined. Existing evidence does not establish a higher incidence than in children without cancer or an oncology-specific syndrome. Standardized definitions, baseline characterization, and prospective multicenter comparative studies are needed to clarify phenotype, recovery, and outcomes.