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Fever in children with chemotherapy-induced neutropenia

Nabil M Ahmed, MD, MPH
Patricia M Flynn, MD
Section Editors
Morven S Edwards, MD
David G Poplack, MD
Deputy Editor
Mary M Torchia, MD


Infection is a major cause of morbidity and mortality in cancer patients [1]. Fever may be the first manifestation of a life-threatening infection, particularly during periods of neutropenia. Febrile episodes occur in approximately one-third of neutropenic episodes in children with chemotherapy-induced neutropenia or after hematopoietic cell transplantation [2]. The approximate rate of occurrence is 0.76 episodes per every 30 days of neutropenia.

The demonstration of markedly reduced infection-related morbidity and mortality with the empiric use of broad-spectrum antibiotics during periods of febrile neutropenia was a major advance in the field of oncology in the 1970s [3,4]. Subsequent studies identified factors associated with a higher risk of bacterial infection and facilitated a more tailored approach to empiric therapy.

Because of important differences between oncology and hematology patients with neutropenia, fever in the pediatric cancer patient during periods of therapy-induced neutropenia are reviewed here. The types of infections and management of fever in the child with other forms of neutropenia are discussed separately. (See "Risk of infection in children with fever and non-chemotherapy-induced neutropenia" and "Evaluation and management of fever in children with non-chemotherapy-induced neutropenia".)

Fever in adult cancer patients with neutropenia is discussed separately. (See "Overview of neutropenic fever syndromes" and "Risk assessment of adults with chemotherapy-induced neutropenia" and "Diagnostic approach to the adult presenting with neutropenic fever" and "Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients)" and "Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications".)


Neutropenia — Neutropenia is defined as an absolute neutrophil count (ANC) <1500 cells/microL. The ANC is calculated using the following formula:


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Literature review current through: Jun 2017. | This topic last updated: Jul 03, 2017.
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