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Guideline review
Managing febrile neutropenia in the UK in 2020
  1. Sheena Guram1,
  2. Aditi Vedi2
  1. 1 Department of Paediatric Haematology and Oncology, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2 Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  1. Correspondence to Dr Sheena Guram, Department of Paediatric Haematology and Oncology, University College London Hospitals NHS Foundation Trust, London, London, UK; s.guram{at}nhs.net

http://dx.doi.org/10.1136/archdischild-2020-319886

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    Background

    Neutropenic sepsis is a life-threatening medical emergency in paediatric haematology and oncology patients. It is a complication of myelosuppressive therapy used to treat children with cancer. Improvement in supportive care in oncology has seen the mortality from febrile neutropenia (FN) fall from 40% to 1%–3% in the last 50 years,1 with the risk of FN in children being reported as low as 0.4%–1%.2 However, many children will still undergo frequent and long inpatient admissions to the hospital, due to fever and neutropenia, while remaining clinically well with no identifiable source of infection. This new guidance draws on evidence from the Predicting Infectious Complications in Children with Cancer collaboration (PICNICC+) collaboration between UK, Australian and Swiss groups to propose a risk-stratified approach to managing these patients and ultimately reducing the time spent in the hospital.3 4 Clinicians and families may find this desirable, particularly during the COVID-19 pandemic while trying to reduce hospital time and keeping patients at home where possible.

    Information about the current guideline

    This guideline has been written by the Children’s Cancer and Leukaemia Group using/adapting the Australian low-risk FN programme.5 Principal treatment centres and their associated paediatric oncology shared care units should consider whether they wish to adopt the protocol as written or to adapt it to fit their needs. The reader should check whether their local hospital policies support ambulatory care management of patients with suspected FN who are at low risk of sepsis.

    This guidance uses the validated Australia–UK–Swiss (‘AUS’) Score to risk stratify patients (see table 1) using three variables: chemotherapy intensity, total white cell count and platelets at admission.

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    Table 1

    AUS Score risk stratification

    Previous guidelines

    There is no previous guidance in the UK …

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    Footnotes

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.