The Indian Journal of Pediatrics

, Volume 80, Issue 2, pp 138–143 | Cite as

Febrile Neutropenia: Outline of Management

  • Sapna Oberoi
  • Renu Suthar
  • Deepak Bansal
  • R. K. Marwaha
Symposium on PGIMER Management Protocols on Oncological Emergencies

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 

References

  1. 1.
    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.Google Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.Google Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Slichter SJ. Evidence-based platelet transfusion guidelines. Hematol Am Soc Hematol Educ. 2007;2007:172–8.CrossRefGoogle Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2012

Authors and Affiliations

  • Sapna Oberoi
    • 1
  • Renu Suthar
    • 1
  • Deepak Bansal
    • 1
  • R. K. Marwaha
    • 1
  1. 1.Hematology-Oncology unit, Department of Pediatrics, Advanced Pediatric CenterPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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