Emergency management of fever and neutropenia in children with cancer: A review
| Autor: | Marian G. Michaels, Christian D. Pulcini, Richard Bounds, Scott H. Maurer, Skyler Lentz, Ramsey Herrington, Richard A. Saladino |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Neutropenia Adolescent Fever medicine.medical_treatment Antineoplastic Agents Physical examination Hematopoietic stem cell transplantation Neoplasms medicine Humans Child Intensive care medicine Chemotherapy medicine.diagnostic_test Emergency management business.industry Age Factors Infant Newborn Infant Cancer General Medicine Emergency department medicine.disease Pediatric cancer Child Preschool Emergency Medicine Emergency Service Hospital business |
| Zdroj: | The American Journal of Emergency Medicine. 50:693-698 |
| ISSN: | 0735-6757 |
| Popis: | Introduction Care of pediatric cancer patients is increasingly being provided by physicians in community settings, including general emergency departments. Guidelines based on current evidence have standardized the care of children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) presenting with fever and neutropenia (FN). Objective This narrative review evaluates the management of pediatric patients with cancer and neutropenic fever and provides comparison with the care of the adult with neutropenic fever in the emergency department. Discussion When children with cancer and FN first present for care, stratification of risk is based on a thorough history and physical examination, baseline laboratory and radiologic studies and the clinical condition of the patient, much like that for the adult patient. Prompt evaluation and initiation of intravenous broad-spectrum antibiotics after cultures are drawn but before other studies are resulted is critically important and may represent a practice difference for some emergency physicians when compared with standardized adult care. Unlike adults, all high-risk and most low-risk children with FN undergoing chemotherapy require admission for parenteral antibiotics and monitoring. Oral antibiotic therapy with close, structured outpatient monitoring may be considered only for certain low-risk patients at pediatric centers equipped to pursue this treatment strategy. Conclusions Although there are many similarities between the emergency approach to FN in children and adults with cancer, there are differences that every emergency physician should know. This review provides strategies to optimize the care of FN in children with cancer in all emergency practice settings. |
| Databáze: | OpenAIRE |
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