Safety and Efficacy of Outpatient Management Strategy for Low-Risk Febrile Neutropenia in Pediatric Oncology: A Tertiary Care Experience in Egypt

Background: Low-risk febrile neutropenia (LRFN) can be managed at home
safely, which also enhances quality of life and lowers medical costs. The
objectives we set were to outline and evaluate the management of LRFN
patients.
Methods: This prospective study enrolled 99 episodes (87 patients) of LRFN
pediatric cancer patients between May 2021 and July 2022. Patients were
categorized into group I (home based management protocol) and group II (in-
patient care strategy).
Results: The median age of patients in this study was 8 years. 72.4%, were
males. Hematological malignancies were reported in 55.2% episodes. Onset of
neutropenia occurred after a median of 8 days and persisted for a median of 6
days. Fever and presence of a focus of infection were reported in 37.4% and
32.3% of the episodes, respectively. Respiratory tract infections (62.5%) were
the main focus of infections recorded in the study. 82% of patients received oral
antibiotics as an outpatient management approach. Seventeen % of patients
received intravenous mono-therapy in the hospital. Recovery was recorded in 90
episodes (90.9%) (95.1% in group I and 70.6% in group II), while failure of
treatment was reported in 4 patients, and 3 in-patient cases shifted to high risk,
and 2 in-patient cases that developed complications (typhilitis and convulsions).
The risk factors for adverse effects were lower CBC parameters (TLC, ANC,
AMC, and PLT), hospital admission and raised CRP.
Conclusion: Outpatient management strategy recorded higher recovery rate
than in patient management strategy.