Febrile neutropenia is a medical emergency; complete the assessment and initiate antibiotics within 60 minutes
Contact the on-call pediatric oncologist within 60 minutes of the patient’s arrival
Reminder: DO NOT take temperature rectally
Absolute neutrophil count (ANC) less than 0.5 x 10⁹ cells/L OR expected to fall to less than 0.5 x 10⁹ cells/L within the next 72 hours.
Complete history, including:
May also consider:
Chest radiography (PA + LAT)
+/- other imaging according to clinical judgment
IV: D5W + NaCl 0.9% at 1.5 x maintenance; maximum of 150 mL/h OR Equivalent oral hydration
Possibility of “afebrile” febrile neutropenia in patients taking corticosteroids; who may present with hypothermia or unexplained clinical deterioration.
Contact the pediatric oncologist or a medical microbiologist/infectious diseases specialist for treatment alternatives if first line agents cannot be used.
If meningitis is suspected, use meropenem (DO NOT use piperacillin+tazobactam)
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