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International Pediatric Fever and Neutropenia Guideline: fever and neutropenia in children receiving chemotherapy (2012)

Thomas Lehrnbecher, Robert Phillips, Sarah Alexander, Frank Alvaro, Fabianne Carlesse, Brian Fisher, Hana Hakim, Maria Santolayo, Elio Castagnola, Bonnie L. Davis, L. Lee Dupuis, Faith Gibson, Andreas H. Groll, Guideline for the Management of Fever and Ne

The Hospital for Sick Children (www.SickKids.ca) present the International Pediatric Fever and Neutropenia Guideline in a long version and in a short version, accessible via their webpage on this guideline. This guideline has been endorsed by the American Society of Pediatric Hematology/Oncology (ASPHO), the Pediatric Oncology Group of Ontario (POGO), the C17 Council, the American Society of Clinical Oncology (ASCO), and the Multinational Association of Supportive Care in Cancer (MASCC). A summary of the recommendations is also available, also as PDF document.

A common complication in children receiving chemotherapy for cancer is fever and neutropenia (FN). Neutropenia is the depletion of neutrophils, that compose the majority of the body’s white blood cells. It is most seen in relation to blood cancers and in patients undergoing hematopoietic stem cell transplantation (HSCT). Fever is the body’s natural response to (e.g. bacterial or fungal) infection. The combination of fever and neutropenia is worrisome as the body may be under attack (infected) while its immunological defenses (white blood cells) are down.

This particular guideline is developed by pediatric cancer and infectious disease expert and provides an evidence-based guideline for empiric FN management in children and adolescents with cancer and/or receiving HSCT. The guideline is targeting the healthcare professionals entrusted with the care of these patients.

The recommendations cover risk stratification, evaluation of the situation and treatment recommendations. Specific recommendations are provided with a timeline: i) for the initial presentation of FN; ii) for the ongoing management, 24-72h after initial anti-bacterial treatment; iii) >96h after initiation of anti-bacterial treatment an anti-fungal treatment is initiated.

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