84 episodes o r fever and neutropenic were recorded in 50 oncologic patients (39 with acute lymphoblosric leukemia, three with acute myeloid leukemia and e ght with dif'eren-solid tumors] which were admitted to c children's university associated public hospital al Santiago Chile. Patients were discharged early after admission if they became non febrile, appeared well, had negative blood cultures and hod normal chest x-ray in spite of absolute neutrophile counts still under 500 per mn 3 h 30 episodes of fever and neutropenia 135,7%) porentera! antibiotic therapy was discontinued and patients were discharged a* mean 5 1 days of hospita;izat on, even while 1 9 patients still had neutropenia in 17 episodes (20.,2%\ intravenous ant'biotic treatment was d scontinued and patients were discharged under oral antibiotic therapy due to minor bacterial infections after mecn 6 1 days of admission, while ten of these patients were still neutropenic. In 37 eosodes (44.1%) longer hospilalization f ime was required [mean 9.9 days) because of confirmed oocteremia, pneumonia or orolonged fever in spite o* resolution o" neutropenia. No neutropenic patient at discharge required readm ssio" to -.ospi'ai within the next seven days and none of them died. Some low risk patients with cancer and febri e neutropenia can be discharged early f rorr hospital in spite of neutropenia.

Selective treatment of febrile neutropenia in pediatric cancer patients Management of pediatric patients with cancer and febrile neutropenia (FN) requires appropriate identification of children at high or low risk of acquiring invasive bacterial infections (IBI), in order to implement selective treatment strategies. Based on international and our own research experience, we propose recommendations for diagnostic screening and management of children with cancer and FN according to their risk of IBI. All pediatric patients with FN must be admitted to hospital for at least 24 hours. During this period clinical and laboratory evaluations are aimed to determine their risk of IBI and to identify potential infectious focii. High risk patients should be managed in the hospital until recovery. Low risk patients can be managed as outpatients. Antimicrobial selection and possible adjustments to therapy will depend on the identification of an infectious focus, and/or local epidemiology and susceptibility patterns. Patients will require periodic clinical and laboratory reevaluation (day 3, 5 and 7 of evolution or more frequently if clinically indicated) irrespective of their risk category; response to treatment can be defined as favorable or unfavorable based in preestablished clinical and laboratory criteria in order to monitor the success of selected strategies.

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