Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.

TitleGuideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.
Publication TypeJournal Article
Year of Publication2012
AuthorsLehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher BT, Hakim H, Santolaya M, Castagnola E, Davis BL, L Dupuis L, Gibson F, Groll AH, Gaur A, Gupta A, Kebudi R, Petrilli S, Steinbach WJ, Villarroel M, Zaoutis TE, Sung L
Corporate AuthorsInternational Pediatric Fever and Neutropenia Guideline Panel
JournalJ Clin Oncol
Volume30
Issue35
Pagination4427-38
Date Published2012 Dec 10
ISSN1527-7755
KeywordsChild, Child, Preschool, Evidence-Based Medicine, Fever, Hematopoietic Stem Cell Transplantation, Humans, Neoplasms, Neutropenia
Abstract

PURPOSE: To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN).

METHODS: The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations.

RESULTS: Recommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented.

CONCLUSION: This guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.

DOI10.1200/JCO.2012.42.7161
Alternate JournalJ. Clin. Oncol.
PubMed ID22987086
Grant List243795 / / Canadian Institutes of Health Research / Canada