Factors Associated with Adverse Outcome in Pediatric Febrile Neutropenia: Results from a Tertiary Care Hospital

Authors

1 Junior Resident, Department of Paediatrics, Kasturba Medical College, Manipal University, Karnataka, India.

2 Former Professor, Department of Paediatrics, Kasturba Medical College, Manipal University, Karnataka, India.

3 Professor, Department of Paediatrics, Kasturba Medical College, Manipal University, Karnataka, India.

4 Professor and Head, Department of Paediatrics, Kasturba Medical College, Manipal University, Karnataka, India.

5 Associate Professor, Department of Paediatrics, Kasturba Medical College, Manipal University, Karnataka, India.

Abstract

Background
Febrile neutropenia with childhood cancer alters the outcome significantly. To study the clinical and laboratory parameters, which predict the outcome among cancer patients with febrile neutropenia this study was undertaken.
Materials and Methods
The study included children less than 18 years with febrile neutropenia episodes. Clinical and hematological / laboratory parameters were recorded during each episode. Hemoglobin, total leucocyte count, platelet count, absolute neutrophil count, absolute monocyte count and serum C- reactive protein (CRP) levels at the onset of febrile neutropenia episode were analyzed as predictors of outcome of febrile neutropenia. The outcome was measured in terms of mortality, duration of fever and need for Intensive care unit (ICU) stay.
Results
The study consisted of 88 episodes in 40 children with a median (IQR) age of 5.9 (3.79, 10) years. In 67.5% of Children's Leukaemiawas the underlying disease. Mean (±SD) hemoglobin concentration was 8.8 ± 1.71 g/dl. Profound neutropenia was seen in 32(36.5%) episodes. Most common infection was lower respiratory infection (30.7%). Absolute monocyte count < 100 cells/cu.mm was found to predict a duration of fever > 7 days (p=0.030).Thrombocytopenia (< 50,000) and CRP (>90 mg/L) were found to be significant predictors of mortality (p
Conclusion
Thrombocytopenia and elevated CRP are significant predictors of mortality and the need for prolonged ICU stay, whereas low hemoglobin level, leukopenia and low absolute neutrophil count (ANC) were not associated with of adverse outcome in febrile neutropenia episodes.

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