Pediatric Benign Neutropenia: Assessing Practice Preferences in Canada

Area of Science:

• Pediatric Hematology
• Oncology
• Immunology

Background:

• Pediatric benign neutropenia is a self-limited condition with a generally benign clinical course.
• However, established guidelines for its diagnosis and management are lacking in the medical literature.
• This variability necessitates an investigation into current clinical practices.

Purpose of the Study:

• To survey pediatric hematology/oncology practitioners in Canada regarding their diagnostic and management strategies for benign neutropenia.
• To identify trends and variations in the approach to fever and neutropenia in children.
• To highlight areas where further research and guideline development are needed.

Main Methods:

• A case-based survey was distributed to pediatric hematology/oncology practitioners across Canada.
• A total of 46 surveys were completed, yielding a response rate of 66%.
• The survey focused on the initial workup, investigations, and treatment decisions for pediatric neutropenia.

Main Results:

• Significant variability exists in the initial workup for fever and neutropenia, with a majority recommending partial septic workup but a notable minority recommending no investigations.
• Management approaches for fever and neutropenia varied, with most recommending admission and intravenous antibiotics, while a substantial portion would discharge patients without antibiotics.
• For chronic neutropenia, antineutrophil antibody testing is infrequently used, and bone marrow biopsy indications vary.
• Granulocyte colony-stimulating factor (G-CSF) use is guided by infection severity and frequency, and most practitioners do not recommend antibiotic prophylaxis.

Conclusions:

• There is considerable heterogeneity in the diagnosis and management of pediatric benign neutropenia among Canadian pediatric hematology/oncology practitioners.
• The findings underscore an urgent need for prospective studies to establish clear diagnostic criteria and evaluate optimal management strategies, particularly for fever in this population.
• Standardization of care is essential to ensure consistent and effective treatment for children with benign neutropenia.