Symposium on PGIMER Management Protocols on Oncological Emergencies

The Indian Journal of Pediatrics

, Volume 80, Issue 2, pp 138-143

Febrile Neutropenia: Outline of Management

  • Sapna OberoiAffiliated withHematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research
  • , Renu SutharAffiliated withHematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research
  • , Deepak BansalAffiliated withHematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research Email author 
  • , R. K. MarwahaAffiliated withHematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Febrile neutropenia is a common emergency encountered in children receiving chemotherapy for a malignancy. Left untreated, it can lead to serious morbidity and mortality. Febrile neutropenia is suspected in any patient on chemotherapy who presents with fever. Prompt evaluation and management by the primary contact pediatrician is essential for a successful outcome. A detailed history and physical examination is warranted to identify source of infection, although two thirds of them may not have localizing symptoms or signs. Risk stratification is valuable in categorizing the severity and guiding therapy. Initial stabilization, prompt initiation of appropriate antibiotics and adequate supportive care are the cornerstone of treatment. Knowledge of the locally prevailing bacteriological profile and antimicrobial susceptibility data is crucial for each hospital/unit to frame and periodically modify guidelines for the choice of antimicrobials. Delay in initiating antimicrobials significantly worsens the outcome. Education of the family as well as the members of the treating unit is important in this regard. Pro-active steps must be taken to reduce incidence of hospital acquired sepsis. Diagnosis and management in relevance to the emergency room is reviewed and institutional practice is shared.

Keywords

Absolute neutrophil count Acute lymphoblastic leukemia ALL Cancer Culture Growth-factors