Neutropenia in the Febrile Child

Ku, Bon; Balamuth, Fran

doi:10.1097/pec.0000000000000809

Cited by 10 publications

(5 citation statements)

References 40 publications

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“…The value of parental involvement in healthcare decision-making and provision has been increasingly recognized in areas other than sepsis, building up on the unique position of parents being experts of their child. Structured parental education on early recognition of severe infections has become standard in the management of oncologic children and children discharged with indwelling medical devices (50, 51). While the setting fever and neutropenia may allow easier operationalization than the more vague concept of sepsis, parents of immunosuppressed children are empowered to raise concerns and are often considered part of the experts in making informed decisions about best care to their children.…”

Section: Discussionmentioning

confidence: 99%

The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

2019

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Background: Sepsis is a time critical disease and outcomes strongly depend on time to initiation of appropriate treatment in hospital. A range of studies have assessed sepsis recognition in hospital settings, whereas little is known about sepsis recognition in the community. The decision-making of parents in seeking medical care may substantially impact survival of children with sepsis. An improved understanding of the parental perspective in recognizing sepsis is urgently needed to inform the design of education campaigns and consideration of using parental concerns as a trigger in sepsis screening tools. Aim: To review the literature on parental concerns in the diagnosis of sepsis in children. Methods: A literature review on parental concerns in pediatric sepsis was performed accessing publications in PubMed, CINAHL and Medline published between 1990 and 2018. In addition, we compared guidelines and online institutional sepsis recognition tools and assessed whether parental concerns were used for screening. Results: Out of 188 articles reviewed, 11 met the criteria. One article was found prospectively assessing the diagnostic performance of parental concern in children evaluated for infection, indicating high positive (16.4) and negative likelihood ratio (0.23) for sepsis/meningitis in presence of parental concerns. The role of parental concern was listed as a sign assisting recognition of sepsis in four studies reporting original data, and six reviews commented on parental concern listed as a factor upon diagnosis of sepsis. When comparing selected examples of institutional sepsis pathways available online, parental concern was variably listed as a criterion to prompt evaluation for sepsis. Conclusions: Despite some guidelines emphasizing the role of parental concern in recognizing sepsis, there is a paucity of data in the field. An improved understanding of whether parental concerns adds diagnostic value to sepsis recognition at acceptable sensitivity and specificity is urgently needed. Future prospective studies should assess whether including parental concerns in sepsis screening tools benefits the assessment resulting in early diagnosis and treatment of children with sepsis.

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Section: Discussionmentioning

confidence: 99%

The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

2019

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“…In patients who are immunocompromised, fever may be the first indication of a life-threatening infection. 8 Recommended care for patients with neutropenia and fever is to administer broad spectrum antibiotics within 60 minutes of arrival to the ED. Achieving the goal of timely antibiotic administration in a pediatric ED can be difficult.…”

Section: Discussionmentioning

confidence: 99%

Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia

Monroe

Cohen

Whelan

et al. 2018

Pediatric Quality &Amp; Safety

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Introduction:In patients who are immunocompromised, fever may indicate a life-threatening infection. Prompt time to antibiotic administration in febrile patients at risk for neutropenia has been identified by national and international panels as a key benchmark of quality care in emergent situations. A quality improvement initiative to improve health care provided in a pediatric emergency department (ED) is described.Methods:A clinical pathway was previously initiated in a pediatric ED with a goal of improving time to antibiotics for febrile neutropenia patients. An agreed upon pathway and order set being initiated. Improvements were seen but not to the desired level. This project involved an improvement cycle that focused on nonvalue added time in the workflow.Results:Percent of patients receiving antibiotics within the goal time of 1 hour increased from 40% to 80% with the intervention. Process measures including arrival to ED bed time, ED bed to antibiotic order time and antibiotic order time to delivery time were followed.Conclusion:Clinical guidelines, order sets and detailed understanding of the actual workflow at the point of care delivery can be instrumental in achieving the goals of reducing time to antibiotics.

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“…[170][171][172] Monitoring of QT interval is recommended in the setting of concomitant triazole prophylaxis. 3 Venetoclax is increasingly used in children with relapsed or refractory leukaemia 173,174 and dose reduction by up to 75% is recommended with concomitant triazole use. 3…”

Section: Impact Of Antifungal Prophylaxis On Diagnostic Testing In Childrenmentioning

confidence: 99%

Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2021

Teh

Yeoh

Haeusler

et al. 2021

Internal Medicine Journal

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Antifungal prophylaxis can reduce morbidity and mortality from invasive fungal disease (IFD). However, its use needs to be optimised and appropriately targeted to patients at highest risk to derive the most benefit. In addition to established risks for IFD, considerable recent progress in the treatment of malignancies has resulted in the development of new 'at-risk' groups. The changing epidemiology of IFD and emergence of drug resistance continue to impact choice of prophylaxis, highlighting the importance of active surveillance and knowledge of local epidemiology. These guidelines aim to highlight emerging risk groups and review the evidence and limitations around new formulations of established agents and new antifungal drugs. It provides recommendations around use and choice of antifungal prophylaxis, discusses the potential impact of the changing epidemiology of IFD and emergence of drug resistance, and future directions for risk stratification to assist optimal management of highly vulnerable patients.

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Neutropenia in the Febrile Child

Cited by 10 publications

References 40 publications

The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review

Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia

Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2021

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