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Early Discharge of Neutropenic Pediatric Oncology Patients Admitted With Fever
Author(s) -
Villanueva Melanie A.,
August Keith J.
Publication year - 2016
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26072
Subject(s) - medicine , neutropenia , odds ratio , bacteremia , retrospective cohort study , absolute neutrophil count , febrile neutropenia , antibiotics , complication , pediatrics , blood culture , sepsis , emergency department , emergency medicine , chemotherapy , psychiatry , microbiology and biotechnology , biology
Background Fever and neutropenia (FN) is a common complication of pediatric oncology therapy and accounts for a large number of hospital admissions. Standard therapy for FN includes hospital admission and empiric antibiotics. Strict adherence to this practice leads to prolonged hospitalizations that may be unnecessary for patients at low risk of having an underlying significant infection. Procedure Children admitted with FN could be discharged after a minimum of 48 hr with no further antibiotic therapy once they had been afebrile for 24 hr with negative blood cultures from initial presentation, regardless of their neutrophil count. We performed a retrospective review with regard to readmissions and subsequent documented infections in FN patients discharged with an ANC of ≤500 cells/mm 3 . Results There were 299 FN admissions in 188 patients who were discharged prior to achieving an ANC of ≥500 cells/mm 3 . Readmission to the hospital during the same period of neutropenia occurred in 50 cases (16.7%) with 27 infections diagnosed in 21 patients. Patients discharged with an ANC of ≤100 cells/mm 3 (odds ratio 3.7) and patients with acute lymphoblastic leukemia (odds ratio 2.6) were more likely to be readmitted for fever. All patients that developed a significant infection had an ANC of ≤100 cells/mm 3 at admission and discharge. In patients that developed a significant infection, only one required admission to the intensive care unit with no deaths. Conclusions The practice of discharging patients with persistent neutropenia who are afebrile with negative blood cultures produces acceptable rates of readmission and subsequent infection and does not lead to increased morbidity and mortality.