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Febrile Neutropenia in Children

Sudden infection risk in cancer treatment when fever appears alongside low neutrophil count.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Febrile Neutropenia in Children?

Febrile neutropenia is fever (>38.5°C oral or >38°C twice) accompanied by an absolute neutrophil count <500/mm³ in cancer patients receiving chemotherapy.

It is most common 7-14 days after chemotherapy and is mostly caused by gram-negative bacterial infection.

Without treatment mortality reaches 60%; with empirical antibiotic within the first hour it falls below 5%; emergency hospitalisation and intravenous antibiotic are mandatory.

Symptoms

Sudden onset fever (>38.5°C) and chills
Unwellness, weakness and decreased appetite
Sore throat, mouth ulcers and difficulty swallowing
Cough, shortness of breath and chest pain
Abdominal pain, diarrhoea and abdominal tenderness
Skin redness, pain and discharge at catheter site
Tachycardia, hypotension and signs of sepsis

Risk Factors

Acute leukaemia (especially AML) and bone-marrow transplant
Intensive chemotherapy (high-dose cytarabine, cyclophosphamide)
Solid-tumour chemotherapy (especially neuroblastoma)
Indwelling central venous catheter (port catheter)
Mucosal damage and prolonged neutropenia (>10 days)
Earlier infection or hospitalisation history
Concomitant steroid use and graft-versus-host disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Children with cancer must immediately present to emergency for any fever
  • Empirical broad-spectrum antibiotic must be started within the first hour
  • Blood culture, urine culture and source detection must be done in parallel
  • G-CSF support and growth-factor therapy may be required

Treatment Methods

01
Immediate empirical antibiotic (piperacillin-tazobactam or cefepime)
02
Aggressive intravenous fluid (20-40 mL/kg)
03
Vancomycin (catheter site infection or MRSA suspicion)
04
Antifungal therapy (caspofungin) if fever persists >5 days
05
G-CSF support (in selected cases)
06
Reverse isolation and contact precautions

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Çocuk Sağlığı ve Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.