Kanser hastası çocuklarda ateş ve nötropeninin yönetimi hakkında kılavuz… (İng)



Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation

  1. Thomas Lehrnbecher,
  2. Robert Phillips,
  3. Sarah Alexander,
  4. Frank Alvaro,
  5. Fabianne Carlesse,
  6. Brian Fisher,
  7. Hana Hakim,
  8. Maria Santolaya,
  9. Elio Castagnola,
  10. Bonnie L. Davis,
  11. L. Lee Dupuis,
  12. Faith Gibson,
  13. Andreas H. Groll,
  14. Aditya Gaur,
  15. Ajay Gupta,
  16. Rejin Kebudi,
  17. Sérgio Petrilli,
  18. William J. Steinbach,
  19. Milena Villarroel,
  20. Theoklis Zaoutis and
  21. Lillian Sung

+ Author Affiliations

1.      Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt; Andreas H. Groll, University Children’s Hospital Muenster, Muenster, Germany; Robert Phillips, Leeds General Infirmary, Leeds, and University of York, York; Faith Gibson, Great Ormond St Hospital and London South Bank University, London, United Kingdom; Sarah Alexander, L. Lee Dupuis, and Lillian Sung, The Hospital for Sick Children, Toronto, Ontario, Canada; Frank Alvaro, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia; Fabianne Carlesse and Sérgio Petrilli, Federal University of São Paulo, São Paulo, Brazil; Brian Fisher and Theoklis Zaoutis, The Children’s Hospital of Philadelphia, Philadelphia, PA; Hana Hakim and Aditya Gaur, St Jude Children’s Research Hospital, Memphis, TN; Maria Santolaya and Milena Villarroel, Hospital Luis Calvo Mackenna and Universidad de Chile, Santiago, Chile; Elio Castagnola, Istituto Giannina Gaslini, Genova, Italy; Bonnie L. Davis, High Tor, Nassau, Bahamas; Ajay Gupta, Institute Rotary Cancer Hospital and All India Institute of Medical Sciences, New Delhi, India; Rejin Kebudi, Istanbul University, Istanbul, Turkey; and William J. Steinbach, Duke University Medical Center, Durham, NC.
  1. Corresponding author: Lillian Sung, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8 Canada; e-mail: [email protected].


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.