Asymptomatic C-reactive protein elevation in neutropenic children

Area of Science:

• Pediatric Hematology Oncology
• Infectious Disease Management
• Clinical Research

Background:

• Febrile neutropenia (FN) is a severe complication in pediatric cancer patients.
• Standardized preventive treatments for childhood FN are lacking.
• Limited data exists on C-reactive protein elevation in afebrile patients with neutropenia (CEAN).

Purpose of the Study:

• To determine the association between CEAN and the subsequent onset of FN.
• To evaluate the effectiveness of broad-spectrum antibiotics in preventing FN in pediatric patients with CEAN.

Main Methods:

• Retrospective review of medical records for 22 pediatric patients with hematologic malignancies (2006-2011).
• Defined CEAN as CRP elevation ≥0.05 mg/dL without fever between blood tests.
• Compared FN incidence within 48 hours of CEAN detection between prophylactic and non-prophylactic antibiotic use.

Main Results:

• CEAN preceded FN onset in 55.6% of observed FN episodes.
• Broad-spectrum antibiotics were used prophylactically in 30 of 95 CEAN episodes.
• Prophylactic antibiotic use significantly lowered FN incidence (6.7% vs. 31%, P < 0.01) within 48 hours of CEAN detection.

Conclusions:

• CEAN is a significant risk factor for developing FN in pediatric cancer patients.
• Prophylactic broad-spectrum antibiotic administration may be a viable strategy to prevent FN development in CEAN patients.