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VOLUME 2 , ISSUE 4 ( October-December, 2020 ) > List of Articles

REVIEW ARTICLE

Management of Febrile Neutropenia in Children: Current Approach and Challenges

Parameswaran Anoop, Channappa N Patil

Citation Information : Anoop P, Patil CN. Management of Febrile Neutropenia in Children: Current Approach and Challenges. Pediatr Inf Dis 2020; 2 (4):135-139.

DOI: 10.5005/jp-journals-10081-1257

License: CC BY-NC 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Neutropenia can result from failure, infiltration, or suppression of the bone marrow due to nonmalignant disorders, cancers, chemotherapy, radiation, or a combination of these. Febrile neutropenia (FN) is a hemato-oncological emergency and is an important cause of death in immunocompromised children. Prompt and stepwise management of FN helps to minimize the morbidity and mortality considerably. In resource-constraint countries, additional challenges can be encountered during the treatment of fever in neutropenic patients. In India, many children with FN are initially treated at regional centers and later referred to tertiary units if needed. Pediatricians should hence be familiar with the treatment algorithm and specific issues related to the management of FN.


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  1. Schwatrzberg LS. Neutropenia: etiology and pathogenesis. Clin Cornerstone 2006;8(Suppl 5):S5–S11. DOI: 10.1016/S1098-3597(06)80053-0.
  2. Lee SJ, Kim JH, Han SB, et al. Prognostic factors predicting poor outcome in cancer patients with febrile neutropenia in the emergency department: usefulness of qSOFA. J Oncol 2018;2018:2183179. DOI: 10.1155/2018/2183179.
  3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. 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(4):e56–e93. DOI: 10.1093/cid/cir073.
  4. Klastersky J, deNaurois J, Rolston K, et al. Management of febrile neutropaenia: ESMO clinical practice guidelines. Ann Oncol 2016;27(Suppl 5):v111–v118. DOI: 10.1093/annonc/mdw325.
  5. Crokaert F. Febrile neutropenia in children. Int J Antimicrob Agents 2000;16(2):173–176. DOI: 10.1016/s0924-8579(00)00239-9.
  6. Basu SK, Fernandez ID, Fisher SG, et al. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Clin Oncol 2005;23(31):7958–7966. DOI: 10.1200/JCO.2005.01.6378.
  7. Prasad M, Chinnaswamy G, Arora B, et al. Risk predictors for adverse outcome in pediatric febrile neutropenia: single center experience from a low and middle income country. Indian J Cancer 2014;51(4):432–437. DOI: 10.4103/0019-509X.175321.
  8. Kar YD, Ozdemir ZC, Bor O. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Pediatri Ars 2017;52(4):213–220. DOI: 10.5152/TurkPediatriArs.2017.5312.
  9. Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol 2008;25(5):385–392. DOI: 10.1080/08880010802106564.
  10. Gupta S, Bonilla M, Gamero M, et al. Microbiology and mortality of pediatric febrile neutropenia in El Salvador. J Pediatr Hematol Oncol 2011;33(4):276–280. DOI: 10.1097/MPH.0b013e31820ff632.
  11. Rackoff WR, Gonin R, Robinson C, et al. Predicting the risk of bacteremia in children with fever and neutropenia. J Clin Oncol 1996;14(3):919–924. DOI: 10.1200/JCO.1996.14.3.919.
  12. Klaassen RJ, Goodman TR, Pham B, et al. “Low-risk” prediction rule for pediatric oncology patients presenting with fever and neutropenia. J Clin Oncol 2000;18(5):1012–1019. DOI: 10.1200/JCO.2000.18.5.1012.
  13. Baorto EP, Aquino VM, Mullen CA, et al. Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and neutropenia. Cancer 2001;92(4):909–913. DOI: 10.1002/1097-0142(20010815)92:43.0.co;2-h.
  14. Alexander SW, Wade KC, Hibberd PL, et al. Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2002;24(1):38–42. DOI: 10.1097/00043426-200201000-00011.
  15. Ammann RA, Hirt A, Luthy R, et al. Predicting bacteremia in children with fever and chemotherapy-induced neutropenia. Pediatr Infect Dis J 2004;23(1):61–67. DOI: 10.1097/01.inf.0000106782.30100.4f.
  16. Paganini HR, Aguirre C, Puppa G, et al. A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer. Cancer 2007;109(12):2572–2579. DOI: 10.1002/cncr.22704.
  17. Ammann RA, Bodmer N, Hirt A, et al. Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study. J Clin Oncol 2010;28(12):2008–2014. DOI: 10.1200/JCO.2009.25.8988.
  18. Hakim H, Flynn PM, Srivastava DK, et al. Risk prediction in pediatric cancer patients with fever and neutropenia. Pediatr Infect Dis J 2010;29(1):53–59. DOI: 10.1097/INF.0b013e3181c3f6f0.
  19. Agyeman P, Aebi C, Hirt A, et al. Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Infect Dis J 2011;30(7):e114–e119. DOI: 10.1097/INF.0b013e318215a290.
  20. Phillips RS, Sung L, Ammann RA, et al. Predicting microbiologically defined infection in febrile neutropenic episodes in children global individual participant data multivariable meta-analysis. Br J Cancer Engl 2016(6):623–630. DOI: 10.1038/bjc.2016.28.
  21. Kern WV. Risk assessment and risk-based therapeutic strategies in febrile neutropenia. Curr Opin Infect Dis 2001;14(4):415–422. DOI: 10.1097/00001432-200108000-00003.
  22. Anoop P, Anjay MA. Febrile neutropenia: transition towards a risk-directed approach. Arch Dis Child 2007;92(5):467–468.
  23. Kumar A, Biswas B, Chopra A, et al. Early discontinuation versus continuation of antimicrobial therapy in low risk pediatric cancer patients with febrile neutropenia, before recovery of counts: a randomized controlled trial (DALFEN study). Indian J Pediatr 2020. Online ahead of print 10.1007/s12098-020-03377-x.
  24. Roy S, Kapoor R, Simalti A, et al. Clinico hematological profile of febrile neutropenia in childhood acute leukemia and utility of serum procalcitonin levels in neutropenic patients. Indian J Crit Care Med 2018;22(5):336–339. DOI: 10.4103/ijccm.IJCCM_516_17.
  25. Haeusler GM, Carlesse F, Phillips RS. An updated systematic review and meta-analysis of the predictive value of serum biomarkers in the assessment of fever during neutropenia in children with cancer. Pediatr Infect Dis J 2013;32(10):e390–e396. DOI: 10.1097/INF.0b013e31829ae38d.
  26. Wadhwa A, Oakley J, Richman J, et al. Time to antibiotic for pediatric oncology patients with febrile neutropenia at regional emergency departments. Pediatr Emerg Care 2020. Online ahead of print 10.1097/PEC.0000000000002160.
  27. Oberoi S, Trehan A, Marwaha RK, et al. Symptom to door interval in febrile neutropenia: perspective in India. Support Care Cancer 2013;21(5):1321–1327. DOI: 10.1007/s00520-012-1668-4.
  28. Klastersky J, Paesmans M, Rubenstein EB, et al. Multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000;18(16):3038–3051. DOI: 10.1200/JCO.2000.18.16.3038.
  29. Byrne MK, Miellet S, McGlinn A, et al. The drivers of antibiotic use and misuse: the development and investigation of a theory driven community measure. BMC Public Health 2019;19(1):1425. DOI: 10.1186/s12889-019-7796-8.
  30. Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 2010;74(3):417–433. DOI: 10.1128/MMBR.00016-10.
  31. Alhaji NB, Aliyu MB, Ghali-Mohammed I, et al. Survey on antimicrobial usage in local dairy cows in North-central Nigeria: drivers for misuse and public health threats. PLoS ONE 2019;14(12):e0224949. DOI: 10.1371/journal.pone.0224949.
  32. Xu J, Sangthong R, McNeil E, et al. Antibiotic use in chicken farms in northwestern China. Antimicrob Resist Infect Control 2020;9(1):10. DOI: 10.1186/s13756-019-0672-6.
  33. Petrosillo N, Taglietti F, Granata G. Treatment options for colistin resistant Klebsiella pneumoniae: present and future. J Clin Med 2019;8(7):934. DOI: 10.3390/jcm8070934.
  34. Bartolleti F, Seco BMS, Capuzzo dos Santos C, et al. Polymyxin B resistance in carbapenem resistant Klebsiella pneumoniae, Sao Paulo, Brazil. Emerg Infect Dis 2016;22(10):1849–1851. DOI: 10.3201/eid2210.160695.
  35. Anoop P, Riley U, Ethell ME, et al. First report of fatal human infections with the cactophilic yeast Sporopachydermia cereana. J Infect 2011;62(4):311–313. DOI: 10.1016/j.jinf.2011.02.008.
  36. Friedman DZP, Schwartz IS. Emerging fungal infections: new patients, new patterns and new pathogens. J Fungi (Basel) 2019;5(3):67.
  37. Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A. The global problem of antifungal resistance: prevalence, mechanisms and management. Lancet Infect Dis 2017;17(12):e383–e392. DOI: 10.1016/S1473-3099(17)30316-X.
  38. Flores V, Miranda R, Merino L, et al. SARS-CoV-2 infection in children with febrile neutropenia. Ann Hematol 2020(8):1–2. Online ahead of print 10.1007/s00277-020-04115-1.
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