Management of Febrile Neutropenia in Children with Cancer; a Practical Guide to Diagnosis and Treatment

This study aimed to provide an evidence-based guideline for the clinical management of febrile neutropenia in children with cancer. In this narrative review, the most recently published sources of information on febrile neutropenia consisting of textbooks and articles, have been reviewed. We focused on the more recent data about diagnosis, treatment and management in children through the use of the MeSH-term words “pediatric patient”, “febrile neutropenia”, “hematologic malignancies”, in Google Scholar, PubMed, Ovid and Science Direct. Meanwhile, our search was not restricted to this particular strategy; we also tried to find all of the most recent available data in the field. Step-by-step recommendations including risk assessment, diagnostic approaches and therapeutic guidelines have been provided in this review. Although the incidence and severity of febrile neutropenia and its complications are inversely proportional to the absolute neutrophil count, it is still possible to determine the risk and categorize patients into high-risk and low-risk groups. Besides, even in high-risk patients, those who are more suspected of severe sepsis also could be identified by well-designed predictor models. This guideline has attempted to provide an evidence-based approach in children with cancer who had fever and neutropenia based on the latest validated reports to be used as a helpful strategy for better management of broad-spectrum antibiotics and resources. This study has provided useful diagnostic and therapeutic guidelines for the management of children with fever and neutropenia, although, in some situations, attention to local epidemiological and bacteriologic data and also further validation of suggested guidelines may still be required.