Abstract:
Introduction: Compared to febrile neutropenia (FN), non-neutropenic fever (NNF)
episodes in children with cancer have not been associated with severe outcomes.
Risk factors for severe outcomes in FN and NNF episodes in children with cancer
from low-middle-income countries (LMIC) are incompletely described.
Methods: A prospective, observational cohort study was conducted at a tertiary
public referral hospital in western Kenya. Inclusion criteria were age ≤14 years,
cancer diagnosis, hospitalized, fever >38.5°C or persistently >38°C. Neutropenia
was an absolute count (ANC) <500 K/μL. Severe outcomes were BSI or death.
Statistical analysis detected significance between groups and a univariate analysis
was conducted.
Results: Of the 99 fevers, 54.5% were NNF episodes. Over 66% of NNF episodes
were in patients with solid tumors. More severe outcomes were observed in NNF
episodes compared to FN [BSI: 7.4% (4/54) vs. 4.4% (2/45); death: 7.4% (4/54) vs.
4.4% (2/45)], yet no deaths occurred in episodes with BSI. Acute leukemia not in
remission (OR= 8.67, 95% CI [CI: 2.3-32.62]; p= 0.002) and concern for disease
relapse (OR= 14.17, 95% CI [2.08-96.3]; p= 0.012) were significantly associated
severe outcomes. Time to antibiotic administration (9 hours) did not differ by
ANC. Under half (45.5%) of fever episodes had a blood culture ordered, with
93.9% obtained after administration of antibiotics.
Discussion: Non-neutropenic fever episodes had more severe outcomes.
Prompt fever management is recommended in all children with cancer treated
in an LMIC setting. Pediatric oncology treatment centers in LMICs shouldrigorously evaluate their fever management clinical practice. Clinical risk factors
were identified, but a risk-stratified approach in an LMIC setting is not
r e c o m m e n d e d . U r g e n t a t t e n t i o n i s n e e d e d t o i d e n t i f y a r e a s o f
clinical improvement.
