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Updated: May 12, 2025
Neutrophil Isolation Protocol
Published on: July 23, 2008
Successful Management of Pediatric Patients with Low-Risk Febrile Neutropenia Using a Clinical Care Pathway in Egypt
Reham Abdelaziz Khedr1,2, Ebtehal Ali1, Hadir Ahmed El-Mahallawy3
1Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
Insights
Implementing strict criteria for low-risk febrile neutropenia in pediatric patients proved safe and effective. This approach successfully reduced admissions and optimized patient care in the emergency department setting.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Diseases
Background:
- Managing low-risk febrile neutropenia in pediatric patients presents challenges in supportive care.
- Strict selection criteria for low-risk febrile neutropenic children can enhance outcomes and reduce complications.
Purpose of the Study:
- To implement and evaluate a clinical pathway for pediatric patients with low-risk febrile neutropenia in the emergency department.
- To assess the safety and efficacy of strict inclusion criteria for home management.
Main Methods:
- A prospective study enrolled 203 pediatric patients from December 2021 to September 2022.
- Risk stratification was performed using a strict checklist, with included patients meeting low-risk criteria.
- Patients received oral antibiotics, education on warning signs, and follow-up at 3 and 7 days.
Main Results:
- Out of 200 episodes, 90.0% of patients were afebrile by day three, though 47.5% remained neutropenic.
- By day seven, all patients were afebrile with recovering counts, and 95.5% achieved absolute neutrophil count recovery.
Conclusions:
- The established inclusion criteria for low-risk febrile neutropenia were safe, with no deaths or ICU admissions.
- This pathway demonstrated success by achieving the lowest admission rate, supporting its use in stewardship programs.
- The criteria aid in avoiding unnecessary admissions and optimizing patient allocation and follow-up.
Background:
Criteria for home management of low-risk febrile neutropenia remain challenging in supportive care. Careful selection of low-risk febrile neutropenic pediatric patients can improve outcomes and decrease complications. In the current study, we implemented a clinical pathway for pediatric patients presenting to the emergency room department with low-risk febrile neutropenia by using strict inclusion criteria.
Materials And Methods:
This is a prospective study from December 2021 to September 2022; all patients presented to the emergency room department were screened for pathway evaluation, and risk stratification was performed using a strict checklist. Patients were included if they met the low-risk criteria. Thorough clinical and laboratory assessments were performed on these patients. All patients started oral antibiotics and were instructed about alarming signs. Patients were followed up at the outpatient clinic on days 3 and 7.
Results:
Two hundred and three patients with 200 episodes of low-risk febrile neutropenia were enrolled; one hundred and ten were males, and 90 were females; underlying hematological malignancies accounted for 54.0%. On day three, 181 patients out of 200 were afebrile for 24 hours (90.0%), and 47.5% were still neutropenic. At day seven, all study patients were afebrile, had recovering counts, and stopped antibiotics regardless of the count. Absolute neutrophil count recovery on day seven was achieved in 95.5% of patients.
Conclusion:
Our inclusion criteria for patients with low-risk febrile neutropenia proved to be safe without deaths or intensive care unit admission and successful with the lowest admission rate, so it can be used for a stewardship program to avoid unnecessary patient admissions and help healthcare givers to optimize patient allocation and follow-up safely.
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