Affiliation:
1. Department of Pediatrics, Madurai Medical College, Madurai, Tamil Nadu, India,
Abstract
Objectives:
The objective of this study was to assess the risk factors for adverse events during febrile neutropenia episodes in children with hematological malignancies.
Material and Methods:
This observational study was carried out in a tertiary care hospital in Madurai over 1 year. Children diagnosed with hematological malignancies and presenting with febrile neutropenia were included (n = 40). A complete blood count was sent for all children who presented with fever >101 F or 100.4 F for >1 h. If absolute neutrophil count <500 mm3, they were included in the study. Clinical and hematological profiles, along with microbiological investigations, were collected. Descriptive statistics in the form of mean, standard deviation, frequency, percentage, and inferential statistics – Chi-square test was done.
Results:
The mean age of children was 6.45 ± 2.08 years. B-cell acute lymphoblastic leukemia was the most common malignancy (80%). Most cases occurred during high-risk stratification (77.5%) and within 7 days of chemotherapy (52.5%). Cytarabine (22.5%) and methotrexate (22.5%) were the most common chemotherapy drugs leading to febrile neutropenia. Clinical features included IV-line cellulitis (22.5%), oral mucositis (22.5%), and gastrointestinal involvement (22.5%). Profound neutropenia (38.9%), low hemoglobin (<5 g/dL) (71.6%), platelet count (<50,000/cu.mm) (46.7%), and microbiologically documented infections (47.2%) were associated with poor outcomes. Gram-negative bacilli, particularly Klebsiella (10%) and Pseudomonas (5%), were commonly isolated. Chances of poor outcome were higher in profound neutropenia (38.9%) compared to severe neutropenia (9.1%) (P < 0.05). Those with microbiologically confirmed infection (47.2%) had poor outcomes compared to clinically documented infection (4.3%) (P < 0.05).
Conclusion:
Risk factors for adverse outcomes include short intervals between chemotherapy and neutropenia, profound neutropenia, low hemoglobin, low platelet count, and microbiologically documented infections.