Hematology-Oncology unit, Department of Pediatrics,. Advanced Pediatric Center, Post Graduate Institute of Medical. Education and Research, Chandigarh ...
Indian J Pediatr DOI 10.1007/s12098-012-0901-y
SYMPOSIUM ON PGIMER MANAGEMENT PROTOCOLS ON ONCOLOGICAL EMERGENCIES
Febrile Neutropenia: Outline of Management Sapna Oberoi & Renu Suthar & Deepak Bansal & R. K. Marwaha
Received: 9 March 2012 / Accepted: 18 September 2012 # Dr. K C Chaudhuri Foundation 2012
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.
a significant cause of morbidity and mortality. It commonly occurs in children diagnosed to have acute leukemia, lymphoma, solid tumor or aplastic anemia [1]. It may result from the underlying malignancy per se or typically due to the effect of chemotherapy. Fever may be the sole manifestation of a serious infection in neutropenic children as other signs of systemic inflammation might be attenuated. Therefore, all children with febrile neutropenia should undergo a systematic evaluation, including a history and physical examination, appropriate diagnostic tests, and prompt initiation of empirical antimicrobial therapy.
Keywords Absolute neutrophil count . Acute lymphoblastic leukemia . ALL . Cancer . Culture . Growth-factors
