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Guideline for Fever and Neutropenia in Children With Cancer

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...
April 24, 2016: Cochrane Database of Systematic Reviews
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
A Vedi, V Pennington, M O'Meara, K Stark, A Senner, P Hunstead, K Adnum, W Londall, L Maurice, Claire Wakefield, R J Cohn
PURPOSE: Febrile neutropenia remains a common, life-threatening complication of chemotherapy in paediatric oncology. Delays in institution of empiric antibiotics have been identified at tertiary and regional centres caring for these patients and associated with decreased survival. Our objective was to reduce the time to administration of empiric antibiotics to less than 60 min from the time of presentation to hospital. METHODS: A retrospective study of the records of oncology patients presenting to the emergency department of a tertiary hospital over a 3-month period was performed and time to first antibiotic administration recorded...
July 2015: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Rüdiger Wessalowski, Dominik T Schneider, Oliver Mils, Verena Friemann, Olga Kyrillopoulou, Jörg Schaper, Christiane Matuschek, Karin Rothe, Ivo Leuschner, Reinhart Willers, Stefan Schönberger, Ulrich Göbel, Gabriele Calaminus
BACKGROUND: Although the survival of children and adolescents with malignant germ-cell tumours has improved greatly in recent years, the outcome remains poor for those with refractory or recurrent malignant germ-cell tumours. We aimed to determine whether objective tumour response could be achieved in patients with refractory or recurrent malignant germ-cell tumours with PEI-regional deep hyperthermia as salvage treatment. METHODS: Patients with refractory or recurrent non-testicular malignant germ-cell tumours after standard cisplatin-based chemotherapy were treated prospectively with PEI chemotherapy (cisplatin 40 mg/m(2), delivered intravenously on days 1 and 4; etoposide 100 mg/m(2), intravenously on days 1-4; and ifosfamide 1800 mg/m(2), intravenously on days 1-4) plus simultaneous 1-h regional deep hyperthermia (41-43°C) on days 1 and 4...
August 2013: Lancet Oncology
Gina Dobrasz, Marianne Hatfield, Laura Masak Jones, Jennifer Joan Berdis, Erin Elizabeth Miller, Melanie Smith Entrekin
INTRODUCTION: Infection is a frequent complication experienced by many children with cancer, with potentially life-threatening consequences that may result in hospitalization, prolonged length of stay, and increased mortality. The need for prompt assessment and early intervention for infection is widely recognized by ED staff as best practice; however, the average length of time to antibiotic administration varies widely in published studies. METHODS: An interdisciplinary quality improvement initiative including physician, nursing, and pharmacy leaders was created to streamline the identification and treatment for this high-risk population...
May 2013: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
F Gibson, J Chisholm, E Blandford, P Donachie, J Hartley, S Lane, K Selwood, R Skinner, R Phillips
PURPOSE: A Delphi study was undertaken to develop a framework guidance that would rationalise and standardise the care of children with febrile neutropenia (FNP) across the UK. METHODS: A mailed Delphi survey was undertaken with health professionals working in children's cancer units. The survey employed two rounds of feedback on 22 practice statements drawn from a systematic review of clinical evidence. Consensus was assumed for any statement where 80+ % of respondents indicated that they "agreed" or "strongly agreed"...
May 2013: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Thomas Lehrnbecher, Robert Phillips, Sarah Alexander, Frank Alvaro, Fabianne Carlesse, Brian Fisher, Hana Hakim, Maria Santolaya, Elio Castagnola, Bonnie L Davis, L Lee Dupuis, Faith Gibson, Andreas H Groll, Aditya Gaur, Ajay Gupta, Rejin Kebudi, Sérgio Petrilli, William J Steinbach, Milena Villarroel, Theoklis Zaoutis, Lillian Sung
PURPOSE: To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN). METHODS: The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines...
December 10, 2012: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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 infections, which can be life-threatening. It has been hypothesised that a low bacterial diet (LBD) can prevent the occurrence of infections and (infection-related) mortality in cancer patients receiving chemotherapy causing episodes of neutropenia, but much remains unclear. OBJECTIVES: The primary objective was to determine the efficacy of an LBD versus a control diet in preventing the occurrence of infection and to decrease (infection-related) mortality in adult and paediatric cancer patients receiving chemotherapy causing episodes of neutropenia...
2012: Cochrane Database of Systematic Reviews
Dat Tran, Michelle Science, David Dix, Carol Portwine, Shayna Zelcer, Donna L Johnston, Rochelle Yanofsky, Adam Gassas, Marie-Chantal Ethier, Lillian Sung
BACKGROUND: The impact of pandemic H1N1 influenza (pH1N1) virus in pediatric cancer is uncertain. The objectives of this study were to characterize the clinical course of pH1N1 and identify factors associated with severe outcomes. METHODS: We conducted a Canadian multicenter retrospective review of children with cancer and stem cell transplant (SCT) recipients who were diagnosed with laboratory-confirmed pH1N1 infection between May 1, 2009 and January 31, 2010. RESULTS: We identified 100 (19 in wave 1 and 81 in wave 2) cases of pH1N1 infection...
November 2012: Influenza and Other Respiratory Viruses
Roland A Ammann, Wim J E Tissing, Bob Phillips
PURPOSE OF REVIEW: Fever in neutropenia is the most frequent potentially life-threatening complication of chemotherapy in children and adolescents with cancer. This review summarizes recent studies that refine our knowledge of how to manage pediatric fever in neutropenia, and their implications for clinical practice and research. RECENT FINDINGS: Many studies have focused on improving risk stratification based on clinical and laboratory characteristics, and on stepping-down treatment in low-risk episodes...
June 2012: Current Opinion in Infectious Diseases
Samart Pakakasama, Kulvadee Surayuthpreecha, Uthen Pandee, Usanarat Anurathapan, Vimolratne Maleewan, Umaporn Udomsubpayakul, Punnee Butthep, Pitak Santanirand, Nongnuch Sirachainan, Suradej Hongeng
BACKGROUND: Patients with febrile neutropenia (FN) may develop severe infection, septic shock, and death. To improve the outcome of pediatric oncology patients with suspected FN, clinical practice guidelines were developed for these patients at the emergency room (ER). The objective of the present study was to evaluate compliance of the clinical practice guidelines for children with cancer presenting with fever to the ER and adverse outcomes after using the guidelines. METHODS: A retrospective cohort study was undertaken of children with cancer presenting with fever to the ER from January 2007 to December 2008 after the clinical guidelines were implemented...
December 2011: Pediatrics International: Official Journal of the Japan Pediatric Society
Hana Hakim, Patricia M Flynn, Katherine M Knapp, Deo Kumar Srivastava, Aditya H Gaur
BACKGROUND: The etiology, clinical course, and outcome of fever and neutropenia (FN) in children with cancer using the current FN guidelines and diagnostic resources in the United States have not been well described. PATIENTS AND METHODS: Medical records of a randomly selected FN episode per patient during 2004-2005 at a pediatric oncology center were reviewed. Patients were managed as per institutional FN guidelines and blood cultures collected in continuously read BACTEC bottles...
September 2009: Journal of Pediatric Hematology/oncology
Stéphane Paulus, Simon Dobson
There is a need for increased consensus in the definition of fever and neutropenia, the approach to risk stratification (including outpatient therapy and early discharge) and choices of empiric antimicrobial therapy in children. There has been an increased incidence of Gram positive infection in FN patients, in particular with VGS in patient with AML. However, Gram negative bacteria are still responsible for most of the mortality associated with FN. Piperacillin/tazobactam, cefipime, or meropenem are all effective first-choice antimicrobial monotherapy in FN...
2009: Advances in Experimental Medicine and Biology
Ana Verena Almeida Mendes, Roberto Sapolnik, Núbia Mendonça
OBJECTIVES: To provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. SOURCES: A review of the scientific literature utilizing an electronic bibliographic search on MEDLINE, Medscape, SciELO, Google, Cochrane and PubMED using the keywords febrile, neutropenic, cancer, children, sepsis, intensive, care. Articles published between 1987 and 2007 were selected, with preference given to review articles, protocols, systematic reviews, epidemiological studies, task force recommendations and phase III clinical trials...
May 2007: Jornal de Pediatria
Bob Phillips, Karen Selwood, Sheila M Lane, Roderick Skinner, Faith Gibson, Julia C Chisholm
OBJECTIVE: To assess the variation in the current UK management strategies for the treatment of febrile neutropenia in childhood. DESIGN AND SETTING: A postal survey of all 21 United Kingdom Children's Cancer Study Group (UKCCSG) centres assessing and collating local policies, protocols or guidelines relating to the management of febrile neutropenia. Further direct contact was undertaken to clarify any uncertainties. RESULTS: All 21 centres provided information...
June 2007: Archives of Disease in Childhood
Hany Ariffin, Chong Lee Ai, Chan Lee Lee, Wan Ariffin Abdullah
AIM: Empirical therapy for children with febrile neutropenia has traditionally consisted of combination antibiotics, usually a beta-lactam and an aminoglycoside. However, recent trends and international guidelines have now made monotherapy a feasible option in the management of this group of patients. We prospectively evaluated the efficacy and safety of cefepime monotherapy in our population of paediatric cancer patients with febrile neutropenia. METHODS: An audit was performed on children aged 16 years and younger presenting with fever and neutropenia who were managed with empirical single-agent cefepime...
December 2006: Journal of Paediatrics and Child Health
H-J Laws, R A Ammann, T Lehrnbecher
The rapid institution of empirical broad-spectrum antibiotics has become the gold standard of treatment for febrile neutropenic children undergoing therapy for cancer. With this approach, morbidity and mortality have dropped significantly but have not been eliminated altogether. In recent randomized studies evaluating different drug combinations, there is still a 3-10 % mortality reported in febrile, neutropenic cancer events. Despite improvements in invasive and non-invasive diagnostic procedures, a majority of patients will receive antibiotic therapy despite an inability to identify a specific pathogen or source (fever of unknown origin, FUO)...
November 2005: Klinische Pädiatrie
Siriwan Wananukul, Issarang Nuchprayoon, Hathaipan Siripanich
Febrile neutropenia is common in children with leukemia. Mucous membrane and skin are most common portals of entry for microorganisms in these patients. The aim of the present study was to find the prevalence of mucocutaneous findings infebrile neutropenic leukemic children. The authors prospectively examined children with fever with neutropenia in acute leukemia, aged 1-15 years, who were admitted to the Department of Pediatrics, King Chulalongkorn Memorial Hospital, between September 2000 and August 2001...
June 2005: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Karianne Wiger, E Arne Høiby, Karl-Olaf Wathne
BACKGROUND: Children undergoing transplantation or treatment for cancer have periods with severe immunosuppression; hence they are very susceptible to infections. A bacterial infection can rapidly become life threatening, and it is crucial to promptly start antibiotic treatment. MATERIALS AND METHODS: The background for this article is a two-day discussion among Norwegian paediatricians about infections in immunosuppressed children. In addition we have reviewed the literature by searches in PubMed, reference books and international guidelines...
May 4, 2005: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
David N Korones
No abstract text is available yet for this article.
December 2004: Pediatric Blood & Cancer
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