What is febrile neutropenia?

摘要

In every paediatric emergency department and children’s assessment unit, the child presenting with a fever while undergoing chemotherapy, is a regular event. These children can look quite well but missing sepsis will be a disaster. Some guidelines will insist in the starting of the antibiotic before even knowing the white cell count result. Measuring and defining fever, agreeing on how to take a temperature and what thermometer to use, are critical when interpreting a child’s temperature. Many of the oncological clinical guidelines on the management of children with fever and neutropenia use a wide range of temperature thresholds and measurement routes to define fever. Prudent use of antibiotics and critical antimicrobial stewardship should be considered in this group of children. Does defining a higher threshold of fever, reduce the use of unnecessary antibiotics and improve the quality of life for these children without increasing the risk of sepsis? Could it also result in less use of diagnostic tests and reduced admission to hospital? Koenig C et al [Lancet Child and Adolescent 2020. DOI: https://doi.org/10.1016/S2352-4642(20)30092-4] have examined if a limit of 39·0°C ear temperature is non-inferior to 38·5°C regarding safety. They have used a cluster-randomised, multiple crossover, non-blinded, non-inferiority study design.