Initial Management of Fever and Neutropenia in a Child With Cancer—The Past, the Present, and the Future

Fever in a patient with an underlying malignancy who has neutropenia is a relatively common event that requires urgent attention because of the risk of associated morbidity and mortality. Although a clinically suspected or microbiologically documented bacterial infection is present in up to half of such febrile neutropenia episodes, an etiology is not identified in the rest. In a neutropenic patient, signs and symptoms of inflammation can be blunted or atypical, and infections may progress unnoticed, resulting in a life-threatening complication. Often, fever is the only manifestation of infection. For these reasons, empirical intravenous broad-spectrum antibiotics in an inpatient setting have long been the mainstay of treatment for febrile neutropenic patients. However, not all febrile neutropenic patients are at the same risk for developing infection-related complications. Addressing this variability in associated risk, risk-stratified management approaches have been suggested to minimize hospital stay, improve patients' quality of life, and decrease related health care costs. This article reviews some guiding principles of initial management of febrile neutropenic children with cancer with a focus on risk-stratified treatment approaches, including the use of inflammatory markers to discern risk.