The effectiveness of quinolone prophylaxis in high-risk hematological pediatric patients is controversial. A systematic review was performed according to PRISMA guidelines, including studies that involved children and young adults undergoing chemotherapy for acute leukemia or HSCT and that received quinolone prophylaxis compared to no prophylaxis. Meta-analysis was performed on blood-stream infections and neutropenic fever. Data regarding the impact of prophylaxis on overall survival, antibiotic exposure, antibiotic-related adverse effects, antibiotic resistance, Clostridium difficile infections, fungal infections, length of hospitalization, and costs were reviewed in the descriptive analysis. Sixteen studies were included in the qualitative analysis and ten of them met the criteria for quantitative analysis. Quinolone prophylaxis resulted effective in reducing the rate of blood-stream infections and neutropenic fever in pediatric acute leukemia compared to no prophylaxis, but it had not a significant effect in HSCT recipients. Prophylaxis was associated with a higher rate of bacterial resistance to fluoroquinolones, and higher antibiotic exposure.

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Objective Preparations with high-titer immunoglobulin-M (HT-IgM) have been used to treat neonatal and adult sepsis as adjuvant to antibiotics. Limited data are available of this use in pediatric oncohematological patients. We retrospectively assessed the characteristics and outcome of febrile episodes treated with broad-spectrum antibiotics and HT-IgM. Methods The study included febrile episodes diagnosed after chemotherapy or hematopoietic stem cell transplantation (HSCT) treated with antibiotics and HT-IgM. Study period was from January 2011 to March 2019. Results Seventy febrile episodes in 63 patients were eligible. In 40% of episodes (n = 28), blood cultures identified a causative organism: Gram-negative (n = 15), Gram-positive (n = 8), polybacterial (n = 4), fungi (n = 1). Twenty-six percent of Gram-negatives were extend spectrum β-lactamase (ESBL)-producers. In 44% of episodes, a deep-organ localization was present, mostly pulmonary. Severe or profound neutropenia, hypotension, and hypoxemia were present in 89, 26, and 21% of episodes, respectively; 20% of episodes required intensive care and 20% of episodes required the use of inotropes. Overall, 90-day mortality was 13% and infection-attributable mortality resulted 8.6%. More than half of the patients received HT-IgM within 24 hours from fever onset. HT-IgM-related allergic reactions occurred in three episodes. Risk factors for 90-day mortality were as follows: hypotension and hypoxemia at fever presentation, admission to intensive care unit (ICU), use of inotropes, presence of deep-organ infection, and escalation of antibiotic therapy within 5 days. Conclusion The combination of broad-spectrum antibiotics and HT-IgM was feasible, tolerated, and promising, being associated with a limited infectious mortality. Further prospective controlled studies are needed to assess the efficacy of this combination over a standard antibiotic approach.

Anaemia is a common issue in the paediatric age group, and it is not uncommon to encounter severe cases of anaemia in the Paediatric Emergency Department. The correct identification of patients requiring urgent care is of central importance in order to provide timely interventions. However, considering that most patients are hemodynamically stable, transfusions are not always mandatory. Even in the setting of the Emergency Department, it is possible to narrow the differential diagnosis with specific laboratory tests. We present three exemplary cases from the experience of a Paediatric Emergency Department that will help us provide a summary of the diagnostic and therapeutic approach to severe anaemia in infants and children.