Management of Febrile Neutropenia in Pediatric Oncology
Summary
Management of febrile neutropenia in paediatric oncology demands rapid assessment, risk stratification and timely intervention to reduce infection-related morbidity and mortality. Central to practice is the administration of empiric broad-spectrum antibiotics at fever onset in patients with an absolute neutrophil count below defined thresholds. Clinical decision rules combining patient characteristics, chemotherapy regimen and infection history are used alongside serum biomarkers to distinguish low- and high-risk episodes. This stratified approach informs choices between inpatient care, early discharge or outpatient oral therapy, as well as the duration of intravenous antimicrobials. Emerging evidence highlights the role of chemotherapy-induced mucosal barrier injury in predisposing to bacteraemia and supports the incorporation of molecular markers into management algorithms. Variations in microbial epidemiology and resource availability drive the need for locally validated protocols, while patient-centred outcomes, including quality of life and cost-effectiveness, shape evolving guidelines. Continued efforts are focused on enhancing diagnostic precision, minimising unnecessary antimicrobial exposure and personalising care pathways for children with cancer.
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Management of Febrile Neutropenia in Pediatric Oncology publication trend
The graph below shows the total number of articles in management of febrile neutropenia in pediatric oncology across all publications each year (not limited to Nature Index journals).
Technical terms
Febrile neutropenia: the occurrence of fever in a patient with an abnormally low neutrophil count, indicating increased risk of infection.
Absolute neutrophil count (ANC): a laboratory measure of circulating neutrophils used to assess the degree of neutropenia.
Bacteraemia: the presence of bacteria in the bloodstream, which can lead to severe complications in immunocompromised patients.
Biomarker: a measurable molecule or parameter that indicates a biological state or condition, such as infection risk.
Empiric broad-spectrum antibiotics: initial antimicrobial therapy targeting a wide range of pathogens before causative organisms are identified.
Mucositis: inflammation and ulceration of the mucous membranes, often induced by chemotherapy, which can predispose to bloodstream infections.
De-escalation: the reduction of antibiotic spectrum or duration based on clinical and microbiological data to minimise adverse effects and resistance.
References
- Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia. Leukemia (2023).
- Diagnosis and Management of Febrile Neutropenia in Pediatric Oncology Patients—A Systematic Review. Diagnostics (2022).
- Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia. Frontiers in Immunology (2021).
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