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neutropenia paediatrics

Kenneth A Michelson, Richard G Bachur, Jason A Levy
OBJECTIVES: The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. METHODS: We performed a retrospective cohort study of all paediatric ED visits over 3 years. Patients were exposed if they arrived during the first hour of a critically ill patient's care...
September 28, 2016: Emergency Medicine Journal: EMJ
Neyssa M Marina, Sigbjørn Smeland, Stefan S Bielack, Mark Bernstein, Gordana Jovic, Mark D Krailo, Jane M Hook, Carola Arndt, Henk van den Berg, Bernadette Brennan, Bénédicte Brichard, Ken L B Brown, Trude Butterfass-Bahloul, Gabriele Calaminus, Heike E Daldrup-Link, Mikael Eriksson, Mark C Gebhardt, Hans Gelderblom, Joachim Gerss, Robert Goldsby, Allen Goorin, Richard Gorlick, Holcombe E Grier, Juliet P Hale, Kirsten Sundby Hall, Jendrik Hardes, Douglas S Hawkins, Knut Helmke, Pancras C W Hogendoorn, Michael S Isakoff, Katherine A Janeway, Heribert Jürgens, Leo Kager, Thomas Kühne, Ching C Lau, Patrick J Leavey, Stephen L Lessnick, Leo Mascarenhas, Paul A Meyers, Hubert Mottl, Michaela Nathrath, Zsuzsanna Papai, R Lor Randall, Peter Reichardt, Marleen Renard, Akmal Ahmed Safwat, Cindy L Schwartz, Michael C G Stevens, Sandra J Strauss, Lisa Teot, Mathias Werner, Matthew R Sydes, Jeremy S Whelan
BACKGROUND: We designed the EURAMOS-1 trial to investigate whether intensified postoperative chemotherapy for patients whose tumour showed a poor response to preoperative chemotherapy (≥10% viable tumour) improved event-free survival in patients with high-grade osteosarcoma. METHODS: EURAMOS-1 was an open-label, international, phase 3 randomised, controlled trial. Consenting patients with newly diagnosed, resectable, high-grade osteosarcoma aged 40 years or younger were eligible for randomisation...
October 2016: Lancet Oncology
Louise Bracken, Jamie Kirkham, Anthony Nunn, Munir Pirmohamed, Matthew Peak, Mark Turner
AIM: To compare a newly developed avoidability assessment tool (AAT) to existing Hallas assessments1 for a set of paediatric ADR cases. METHOD: The new AAT was employed to assess 249 case reports of ADRs causing admission to hospital. The case reports contained a description of the ADR, details of suspected and concurrent medication and past medical history. Each case report was independently assessed and an avoidability category assigned. For ADRs categorised as either 'possibly' or 'definitely avoidable' a rationale was recorded...
September 2016: Archives of Disease in Childhood
Jasodhara Chaudhuri, Tamoghna Biswas, Jyotishka Datta, Tapas Kumar Sabui, Sukanta Chatterjee, Somosri Ray, Dibyendu Raychaudhuri, Kalyanbrata Mandal, Kaushani Chatterjee, Swapna Chakraborty
AIM: Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. METHODS: A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included...
July 2016: Journal of Paediatrics and Child Health
Robert S Phillips, Kaljit Bhuller, Lillian Sung, Roland A Ammann, Wim J E Tissing, Thomas Lehrnbecher, Lesley A Stewart
BACKGROUND: Risk-stratified management of febrile neutropenia (FN) allows intensive management of high-risk cases and early discharge of low-risk cases. Most risk stratification systems predicting severe infection from admission variables have been derived from childhood or adult populations and consequently their value in adolescents/young adults (AYA) may vary. Our objective was to determine their value in this population. METHODS: Data from the 'predicting infectious complications in children with cancer' (PICNICC) individual participant data collaboration were used to evaluate six previously described risk stratification schema in the AYA population...
September 2016: European Journal of Cancer
Maia De Luca, Daniele Donà, Carlotta Montagnani, Andrea Lo Vecchio, Marta Romanengo, Claudia Tagliabue, Chiara Centenari, Patrizia D'Argenio, Rebecca Lundin, Carlo Giaquinto, Luisa Galli, Alfredo Guarino, Susanna Esposito, Mike Sharland, Ann Versporten, Herman Goossens, Giangiacomo Nicolini
BACKGROUND: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions...
2016: PloS One
Giuseppe Pontrelli, Franco De Crescenzo, Roberto Buzzetti, Francesca Calò Carducci, Alessandro Jenkner, Donato Amodio, Maia De Luca, Sara Chiurchiù, Elin Haf Davies, Alessandra Simonetti, Elena Ferretti, Martina Della Corte, Luca Gramatica, Susanna Livadiotti, Paolo Rossi
BACKGROUND: Differential diagnosis between sepsis and non-infectious inflammatory disorders demands improved biomarkers. Soluble Triggering Receptor Expression on Myeloid cells (sTREM-1) is an activating receptor whose role has been studied throughout the last decade. We performed a systematic review to evaluate the accuracy of plasma sTREM-1 levels in the diagnosis of sepsis in children with Systemic Inflammatory Response Syndrome (SIRS). METHODS: A literature search of PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ISI Web of Knowledge databases was performed using specific search terms...
2016: Italian Journal of Pediatrics
Elvira C van Dalen, Arno Mank, Edith Leclercq, Renée L Mulder, Michelle Davies, Marie José Kersten, Marianne D van de Wetering
BACKGROUND: Neutropenia is a potentially serious side effect of chemotherapy and a major risk factor for infection, which can be life-threatening. It has been hypothesised that a low bacterial diet (LBD) can prevent infection and (infection-related) mortality in cancer patients receiving chemotherapy that causes episodes of neutropenia, but much remains unclear. This review is an update of a previously published Cochrane review. OBJECTIVES: The primary objective of this review was to determine the efficacy of an LBD versus a control diet in preventing infection and in decreasing (infection-related) mortality in adult and paediatric cancer patients receiving chemotherapy that causes episodes of neutropenia...
2016: Cochrane Database of Systematic Reviews
Ignacio Ruiz Del Olmo Izuzquiza, Matilde Bustillo Alonso, María Luisa Monforte Cirac, Pedro Burgués Prades, Carmelo Guerrero Laleona
OBJECTIVE: To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). MATERIAL AND METHODS: A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. INCLUSION CRITERIA: patients with lymphadenitis and positive culture...
April 1, 2016: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Christopher C Stanley, Kate D Westmoreland, Brett J Heimlich, Nader K El-Mallawany, Peter Wasswa, Idah Mtete, Mercy Butia, Salama Itimu, Mary Chasela, Mary Mtunda, Mary Chikasema, Victor Makwakwa, Bongani Kaimila, Edwards Kasonkanji, Fred Chimzimu, Coxcilly Kampani, Bal M Dhungel, Robert Krysiak, Nathan D Montgomery, Yuri Fedoriw, Nora E Rosenberg, N George Liomba, Satish Gopal
Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9·2 years (interquartile range 7·7-11·8), 48 (66%) were male and two were positive for human immunodeficiency virus...
June 2016: British Journal of Haematology
Karin G E Miedema, Wim J E Tissing, Floor C H Abbink, Lynne M Ball, Erna M C Michiels, Michel J van Vliet, Wilma Y de Vries, Willem A Kamps, Obbe F Norbruis, Marta Fiocco, Hester A de Groot-Kruseman, Marianne D van de Wetering, Eveline S J M de Bont
BACKGROUND: In this national multicentre study, we examined the safety of reducing antibiotics in selected paediatric cancer patients with febrile neutropenia. METHODS: Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk and received antibiotic therapy. Remaining patients were allocated to low- or medium risk, depending on their interleukin-8 level. Low-risk patients did not receive any antibiotics and were discharged from the hospital after having been afebrile for 12 h...
January 2016: European Journal of Cancer
Mohammad Aamir, Pankaj Abrol, Deepak Sharma, Harish Punia
OBJECTIVE: To evaluate clinically the efficacy and safety in northern India of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia. MATERIAL AND METHODS: Children aged ≤18 years admitted febrile with chemotherapy-induced neutropenia were randomised into two groups comprising 20 cases in each group viz. CEF (receiving cefepime only) and PIP-TAZO (receiving piperacillin-tazobactam). Based on clinical and laboratory tests, patients were classified into: microbiologically documented infections (MDI); clinically documented infections (CDI); and unexplained fever (UF)...
July 2016: Tropical Doctor
Denise Lawrie, Helen Payne, Martin Nieuwoudt, Deborah Kim Glencross
BACKGROUND: The paediatric full blood count and lymphocyte subset reference intervals used by the National Health Laboratory Service (NHLS), South Africa (SA), are taken from two international reference interval publications. Differences in reference intervals suggest that international data sets may not be appropriate for use in SA. OBJECTIVE: To study immunohaematological values of a group of clinically healthy children from an informal settlement in Cape Town, SA, to assess whether international paediatric reference intervals used by the NHLS are appropriate...
July 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Sebastian Botzenhardt, Chor W Sing, Ian C K Wong, Godfrey Chi-Fung Chan, Lisa Y L Wong, Mariagrazia Felisi, Wolfgang Rascher, Adriana Ceci, Antje Neubert
UNLABELLED: There is a lack of knowledge regarding the incidence of serious adverse drug reactions (ADR) to the oral iron chelator deferiprone in Chinese children with transfusion-dependent thalassaemia. In this retrospective population-based cohort study, paediatric thalassaemia patients in Hong Kong were screened for serious and medically important adverse events related to deferiprone therapy using diagnosis codes, laboratory data and hospital admissions. Potential ADRs were assessed by reviewing concomitant medications, diagnoses and laboratory data and evaluated using standardised causality assessment...
2016: Current Drug Safety
Gabrielle M Haeusler, Lillian Sung, Roland A Ammann, Bob Phillips
PURPOSE OF REVIEW: Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS: A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis...
December 2015: Current Opinion in Infectious Diseases
Pascal Chastagner, Bénédicte Devictor, Birgit Geoerger, Isabelle Aerts, Pierre Leblond, Didier Frappaz, Jean-Claude Gentet, Serge Bracard, Nicolas André
PURPOSE: To determine the maximum recommended dose (RD) and pharmacokinetics of Myocet®, a non-pegylated liposomal doxorubicin, in children. METHODS: Eligible patients were children with refractory high-grade glioma who had received prior chemotherapy and radiotherapy but no anthracyclines. Cohorts of at least three patients each received escalating doses of Myocet® starting at 60 mg/m(2) at 3-week intervals, administered intravenously over 1 h, and then doses were escalated to 75 mg/m(2) corresponding to the adult RD...
August 2015: Cancer Chemotherapy and Pharmacology
R A Ammann, H J Laws, D Schrey, K Ehlert, O Moser, D Dilloo, U Bode, A Wawer, A Schrauder, G Cario, A Laengler, N Graf, R Furtwängler, A Simon
UNLABELLED: In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%)...
May 2015: European Journal of Pediatrics
Hyoung Jin Kang, Susan Loftus, Arlene Taylor, Cara DiCristina, Stuart Green, Christian Michel Zwaan
BACKGROUND: Oral aprepitant, a neurokinin-1 receptor antagonist, is recommended in combination with other anti-emetic agents for the prevention of nausea and vomiting associated with moderately or highly emetogenic chemotherapy in adults, but its efficacy and safety in paediatric patients are unknown. We did this phase 3 trial to examine the safety and efficacy of such treatment in children. METHODS: In this final analysis of a phase 3, randomised, multicentre, double-blind study, patients aged 6 months to 17 years with a documented malignancy who were scheduled to receive either moderately or highly emetogenic chemotherapy were randomly assigned with an interactive voice response system to an age-based and weight-based blinded regimen of aprepitant (125 mg for ages 12-17 years; 3·0 mg/kg up to 125 mg for ages 6 months to <12 years) plus ondansetron on day 1, followed by aprepitant (80 mg for ages 12-17 years; 2·0 mg/kg up to 80 mg for ages 6 months to <12 years) on days 2 and 3, or placebo plus ondansetron on day 1 followed by placebo on days 2 and 3; addition of dexamethasone was allowed...
April 2015: Lancet Oncology
Nicola Principi, Susanna Esposito
With the increasing resistance to antibiotics among common bacterial pathogens, challenges associated with the use of fluoroquinolones (FQs) in paediatrics have emerged. The majority of FQs have favourable pharmacokinetic properties, although these properties can differ in children compared with adults. Moreover, all FQs have broad antimicrobial activity both against Gram-positive and Gram-negative bacteria. However, only some FQs for which adequate studies are available have been approved for use in children in a limited number of clinical situations owing to the supposed risk of development of severe musculoskeletal disorders, as demonstrated in juvenile animals...
April 2015: International Journal of Antimicrobial Agents
J Zhang, P Barbaro, Y Guo, A Alodaib, J Li, W Gold, L Adès, B J Keating, X Xu, J Teo, H Hakonarson, J Christodoulou
Next-generation sequencing (NGS) has now evolved to be a relatively affordable and efficient means of detecting genetic mutations. Whole genome sequencing (WGS) or whole exome sequencing (WES) offers the opportunity for rapid diagnosis in many paediatric haematological conditions, where phenotypes are variable and either a large number of genes are involved, or the genes are large making sanger sequencing expensive and labour-intensive. NGS offers the potential for gene discovery in patients who do not have mutations in currently known genes...
February 2016: Clinical Genetics
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