Safety of early hospital discharge of selected febrile children and adolescents with cancer with prolonged neutropenia

V. M. Aquino, G. R. Buchanan, I. Tkaczewski, M. M. Mustafa

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Problem. The safety of early hospital discharge (i.e., before the absolute neutrophil count [ANC] exceeds 500 cell/mm3) of febrile neutropenic children and adolescents with cancer who had experienced prolonged neutropenia (i.e., for more than 7 days) following admission has not been studied. Method of Study. Three hundred and thirty nine consecutive admissions of children and adolescents with cancer for management of febrile neutropenia were reviewed. Early discharge criteria included absence of fever for 24 hours prior to discharge, sterile blood cultures for 24 horus, evidence of bone marrow recovery defined as a sustained increase in platelet count and ANC or absolute phagocyte count (APC), and control of local infection if present. Children hospitalized with febrile neutropenia who remained neutropenic for more than 7 days were analyzed to assess their outcomes following discharge if they had met criteria for early hospital discharge. Results. Thirty-three patients in whom neutropenia had persisted for more than 7 days were discharged before attaining an ANC greater than 500/mm3 when they met the early discharge criteria. Only two children (6%) required readmission for recurrent fever, a rate which was not different from that of patients discharged after a more transient episode of neutropenia (2 of 33 vs. 3 of 121, P = 0.3). Both patients who were readmitted had a source of local infection which worsened despite oral antibiotics. Both patients appeared clinically well at the time of readmission and had sterile cultures during their second hopsitalization with resolution of local infection. Conclusion. This study confirms that low-risk criteria used to select children with cancer for discharge before complete resolution of neutropenia can be safely applied to those patients whose neutropenia lasted more than 7 days following admission.

Original languageEnglish (US)
Pages (from-to)191-195
Number of pages5
JournalMedical and Pediatric Oncology
Volume28
Issue number3
DOIs
StatePublished - 1997

Fingerprint

Neutropenia
Fever
Safety
Febrile Neutropenia
Neutrophils
Neoplasms
Hospitalized Child
Phagocytes
Infection Control
Infection
Platelet Count
Bone Marrow
Anti-Bacterial Agents

Keywords

  • bacteremia
  • fever
  • neoplasia
  • neutropenia
  • pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Cancer Research

Cite this

Safety of early hospital discharge of selected febrile children and adolescents with cancer with prolonged neutropenia. / Aquino, V. M.; Buchanan, G. R.; Tkaczewski, I.; Mustafa, M. M.

In: Medical and Pediatric Oncology, Vol. 28, No. 3, 1997, p. 191-195.

Research output: Contribution to journalArticle

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abstract = "Problem. The safety of early hospital discharge (i.e., before the absolute neutrophil count [ANC] exceeds 500 cell/mm3) of febrile neutropenic children and adolescents with cancer who had experienced prolonged neutropenia (i.e., for more than 7 days) following admission has not been studied. Method of Study. Three hundred and thirty nine consecutive admissions of children and adolescents with cancer for management of febrile neutropenia were reviewed. Early discharge criteria included absence of fever for 24 hours prior to discharge, sterile blood cultures for 24 horus, evidence of bone marrow recovery defined as a sustained increase in platelet count and ANC or absolute phagocyte count (APC), and control of local infection if present. Children hospitalized with febrile neutropenia who remained neutropenic for more than 7 days were analyzed to assess their outcomes following discharge if they had met criteria for early hospital discharge. Results. Thirty-three patients in whom neutropenia had persisted for more than 7 days were discharged before attaining an ANC greater than 500/mm3 when they met the early discharge criteria. Only two children (6{\%}) required readmission for recurrent fever, a rate which was not different from that of patients discharged after a more transient episode of neutropenia (2 of 33 vs. 3 of 121, P = 0.3). Both patients who were readmitted had a source of local infection which worsened despite oral antibiotics. Both patients appeared clinically well at the time of readmission and had sterile cultures during their second hopsitalization with resolution of local infection. Conclusion. This study confirms that low-risk criteria used to select children with cancer for discharge before complete resolution of neutropenia can be safely applied to those patients whose neutropenia lasted more than 7 days following admission.",
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