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Outcomes of Immunocompetent Children Presenting with Fever and Neutropenia

Osnat Wittmann1, Ayelet Rimon1, Dennis Scolnik2

  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

The Journal of Emergency Medicine
|December 16, 2017
PubMed

Insights

Febrile children with severe neutropenia (low neutrophil count) have a low risk of severe bacterial infection. Outcomes are similar to those with moderate neutropenia, suggesting watchful waiting may be appropriate.

Area of Science:

  • Pediatric Emergency Medicine
  • Hematology

Background:

  • Fever and neutropenia in children can cause clinical concern.
  • Evaluation is often extensive, even in immunocompetent children.

Purpose of the Study:

  • To determine outcomes for previously healthy, febrile children presenting with severe neutropenia.

Main Methods:

  • Retrospective review of infants and children (3-36 months) with fever and severe neutropenia (neutrophil count <500 × 10^3/μL).
  • Comparison with a similar cohort experiencing moderate neutropenia (500-1000 × 10^3/μL).

Main Results:

  • Severe bacterial infection (SBI) occurred in 1.9% of 52 patients with severe neutropenia.
  • No significant difference in SBI incidence was observed compared to patients with moderate neutropenia.

Conclusions:

  • Immunocompetent children with fever and severe neutropenia do not have an increased risk of SBI compared to those with moderate neutropenia.
  • Close monitoring of blood counts for bone marrow recovery may be a viable alternative to antibiotics.
Abstract

Keywords:
bacteremianeutropeniapneumococcal vaccinesevere bacterial infection

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