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.
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Walsh TJ. Infectious complications in pediatric cancer patients. In: Pizzo PA, Poplack DG, eds. Principles and practice of pediatric oncology. 5th ed; Philadelphia: Williams and Wilkins; 2006. pp. 1269–329.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:427–31.
Badiei Z, Khalesi M, Alami MH, et al. Risk factors associated with life-threatening infections in children with febrile neutropenia: a data mining approach. J Pediatr Hematol Oncol. 2011;33:e9–e12.
Härtel C, Deuster M, Lehrnbecher T, Schultz C. Current approaches for risk stratification of infectious complications in pediatric oncology. Pediatr Blood Cancer. 2007;49:767–73.
Vidal L, Paul M, Ben-Dor I, Pokroy E, Soares-Weiser K, Leibovici L. Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients. Cochrane Database Syst Rev. 2004;4:CD003992.
Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol. 2008;25:385–92.
Kanafani ZA, Dakdouki GK, El-Chammas KI, Eid S, Araj GF, Kanj SS. Bloodstream infections in febrile neutropenic patients at a tertiary care center in Lebanon: a view of the past decade. Int J Infect Dis. 2007;11:450–3.
Mathur P, Chaudhry R, Kumar L, Kapil A, Dhawan B. A study of bacteremia in febrile neutropenic patients at a tertiary-care hospital with special reference to anaerobes. Med Oncol. 2002;19:267–72.
Manji A, Lehrnbecher T, Dupuis LL, Beyene J, Sung L. A systematic review and meta-analysis of anti-pseudomonal penicillins and carbapenems in pediatric febrile neutropenia. Support Care Cancer. 2012;20:2295–304.
Bansal D, Gautam P, Dubey ML, Marwaha RK. Presumptive treatment for malaria is not justified in children receiving cancer chemotherapy. Pediatr Blood Cancer. 2010;55:1108–10.
Centers for Disease Control and Prevention; Infectious Disease Society of America; American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep. 2000;49:1–125.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.
Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344:481–7.
Pancera CF, Hayashi M, Fregnani JH, Negri EM, Deheinzelin D, de Camargo B. Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit. J Pediatr Hematol Oncol. 2008;30:533–8.
Slichter SJ. Evidence-based platelet transfusion guidelines. Hematol Am Soc Hematol Educ. 2007;2007:172–8.
Blajchman MA, Slichter SJ, Heddle NM, Murphy MF. New strategies for the optimal use of platelet transfusions. Hematol Am Soc Hematol Educ Progr. 2008:198–204.
Smith T, Khatcheressian J, Lyman G, et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence based clinical practice guideline. J Clin Oncol. 2006;24:3187–205.
Ozkaynak MF, Krailo M, Chen Z, Feusner J. Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2005;45:274–80.
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Oberoi, S., Suthar, R., Bansal, D. et al. Febrile Neutropenia: Outline of Management. Indian J Pediatr 80, 138–143 (2013). https://doi.org/10.1007/s12098-012-0901-y
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DOI: https://doi.org/10.1007/s12098-012-0901-y