Update on Febrile Neutropenia in Pediatric Oncological Patients Undergoing Chemotherapy

Abstract

Febrile neutropenia (FN) is a common complication of chemotherapy in oncological children and one of the most important causes of morbidity and mortality in these patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome. We analyzed the literature in order to clarify the epidemiology of FN in children undergoing chemotherapy, the specific factors associated with a negative outcome, the most common etiology, and the value of biological markers as a tool to make an early diagnosis or to monitor the evolution of the infection. Several studies have tried to identify specific factors that could help the clinician in the detection of an infection and in its microbiological identification. However, due to the heterogenicity of the available studies, sufficient evidence is lacking to establish the role of these risk factors in clinical practice and future research on this topic appear mandatory. Determinations of risk factors, etiology, and markers of febrile episodes in these patients are complicated by the characteristics of the underlying illness and the effects of treatments received. Although some studies have tried to develop an evidence-based guideline for the empiric management of FN in pediatrics, validated predictive scores and algorithms are still lacking and urgently needed.

Prevalence of Antibiotic Resistance in Pediatric Malignancy Patients: A Two-Year Retrospective Study in Basra City

“…In this study, we discovered a statistically significant relationship between the length of the hospital stay and febrile neutropenia, chemotherapy side effects, and infection severity (p-value 0.0001). These findings concur with this research (17) , however, there was no significant association between severity of infection and gender and type of malignancy respectively P value ( 0.9078, 0.7704). These results are different from this study (18) .…”

Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017

“…The findings of our study indicate that cancer was positively associated with a higher number of annual ED visits, hospital admissions after an ED visit, and mortality, similar to previous studies in both pediatric patients and adult patients with cancer 17,22 . Pediatric patients with cancer receive cytotoxic therapies associated with various serious acute toxicities, and may result in immunosuppression and in turn to febrile neutropenia (FN) that predisposes the child to sepsis from common bacterial etiologies and opportunistic infections 23 . As our findings indicate, the increased admission and mortality rate after an ED visit for pediatric patients with cancer, compared to those without cancer, can be further attributed to the increased risks of sepsis.…”

“…17,22 Pediatric patients with cancer receive cytotoxic therapies associated with various serious acute toxicities, and may result in immunosuppression and in turn to febrile neutropenia (FN) that predisposes the child to sepsis from common bacterial etiologies and opportunistic infections. 23 As our findings indicate, the increased admission and mortality rate after an ED visit for pediatric patients with cancer, compared to those without cancer, can be further attributed to the increased risks of sepsis. Children with FN may have subtle signs of sepsis, warranting their referral to the ED for a complete evaluation, as early treatment has been associated with improved outcomes.…”

Febrile illness in high-risk children: a prospective, international observational study

“…This approach has led to a significant reduction in mortality and morbidity [15], but consequently antibiotic overuse, increased risk of antimicrobial resistance, and prolonged hospitalisation. Fever accounts for 60.2% of emergency department (ED) attendance in paediatric cancer [16] and is a significant burden for caregivers [17] and healthcare systems.…”