Management of febrile neutropenia in pediatric cancer patients

Abstract

Introduction: Febrile neutropenia (FN) is the most common complication that threatens the life of patients undergoing chemotherapy. It is considered an oncological emergency and its therapeutic decisions must be timely and accurate. Objective: To evaluate the therapeutic approach given to pediatric cancer patients with episodes of neutropenia and fever. Material and methods: Descriptive, observational, cross-sectional and retrospective study in children with acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), Burkitt's lymphoma (BL) and lymphoblastic lymphoma (LL) who attended the hematology service from 2014 to 2018. Age, gender, underlying diagnosis, treatment phase, absolute neutrophil count, clinical manifestations, blood culture collection and results, initial antimicrobial therapy, treatment changes, complications, days of hospital stay and mortality were analyzed. Descriptive statistics was used, with measures of central tendency, percentages and frequencies with the SPSS v22 program. Results: We identified 104 episodes of FN in 70 patients with cancer. The mean age was 7 years and majority of patients were male (n=49, 70.0%). ALL was the most frequent underlying malignancy (n=59, 84.3%) and the highest amount of FN episodes occurred during the induction phase (n=74, 71.2%). Fever of unknown origin was observed in 29 (27.9%) episodes. Blood cultures were collected in 14 (13.5%) cases. The most commonly isolated microorganisms in blood culture were Gram-positive bacteria (n=10, 76.9%). β-lactams and aminoglycosides were the most common antibiotics used. Conclusions: Febrile neutropenia is a frequent complication in the pediatric population with hemato-oncological diseases in our hospital. The therapeutic approach that patients receive is adequate.