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In children undergoing treatment for ALL, elevations in liver enzymes may be primarily due to hepatitis viruses. However, maintenance therapy using known hepatotoxic drugs, may have additive deleterious effects. Liver enzymes are normalized in affected patients when maintenance therapy is temporarily suspended.

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The child suffering from neutropenia undergoing chemotherapy is demanding and requiring the integration of skills from numerous different specialties. These children often have prolonged hospitalizations, which may be marked by many complications. The aim of this study to design, implement and evaluate the effect of a clinical pathway for children with neutropenia undergoing chemotherapy.Quasi experimental research design was used. The study was carried out at Tanta Cancer Center Affiliated to the Ministry of Health. Out patient Clinic of Oncology and Inpatient Pediatric Oncology Department in Benha Children Hospital. 72 children with neutropenia undergoing chemotherapy was recruited for the study. Four tools were used for data collection, questionnaire sheet, Nutritional Assessment Sheets, Complication monitor sheet and follow pathway design for the study group. The result of the study revealed that there was no statistically significant difference between the study and control groups on admission but there was a statistically significant difference between the study and control groups after the implementation of the clinical pathway for the study group compared with the routine hospital policy care. Conclusion: Children with neutropenia undergoing chemotherapy to whom clinical pathway was applied fewer complications, less hospital stay and less readmission than those who received routine hospital care. Recommendations: Clinical pathway should be integrated into the routine nursing care for children with neutropenia undergoing chemotherapy.