Chemotherapy-Induced Febrile Neutropenia Managed on an Outpatient Basis at the Pediatric Hematology and Oncology Department of the Ibn Sina Children’s Hospital in Rabat

Abstract

Introduction: Febrile neutropenia (FN) is an important cause of morbidity and mortality in patients with cancer. The general objective of this study was to collect data and analyze the factors influencing management of the febrile neutropenia at the day hospital at the pediatric department of Hematology and Oncology (SHOP) of Rabat.

Patients and Methods: It was a cross-sectional study descriptive and analytical for a period of 3 months (from January 9 to March 31, 2017) which was made at the day hospital at the SHOP. The inclusion criteria were neutropenia (rate of the neutrophil account lower or equal to 500/mm3) and fever following a cure of cancer chemotherapy.

Results: We have registered 43 cases of FN over a period of 3 months. The most affected age group was less than 5 years with a median age of 4 years and ranged from 0 to 15 years. The ALL accounted for 67.4%; 51% of patients lived between 100 and 299 km from the SHOP, and 76.7% of patients have made 1 to 6 hours to reach the SHOP. The median of the neutrophil rate was 100/mm3. Twenty cases (46.5%) had a rate of neutrophil account < 100/mm3 . Nine (20.9%) had signs related to infection. Twenty-five (58.1%) have been treated with mono antibiotic therapy, and 16 patients (37.2%) were treated with a bi antibiotic therapy. Fifteen cases (34.9%) were hospitalized for not getting the pyrexia after 72 h of antibiotic therapy.There were no deaths among
hospitalized patients. Ninety three percent of the therapeutic education was made by the doctor. Bi-varied analysis showed that evolution depended on the depth of neutropenia.

Conclusion: Outpatients treatment with febrile neutropenia at the day hospital is possible and must take account of the clinical status, isolation of patients and the neutrophil account. Education of patients and parents and stratification of cases are mandatory