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Home | Articles | Emergencies | Paediatric Febrile Neutropenia Guidance

Paediatric Febrile Neutropenia Guidance

Last updated 4th August 2023

FEBRILE NEUTROPENIA IS A CLINICAL EMERGENCY

All of our Haematology/Oncology patients have shared care with GG&C.

Criteria

  • Any child identified as being at risk of febrile neutropenia, with a single temperature of 38C or above meets the criteria for treatment.
  • Any child who looks unwell or rigors regardless of temperature and neutrophil count should commence treatment.

Process

  • Call received to emergency triage phone and telephone triage tool completed and identifies requirement for admission and suspected Febrile Neutropenia.
  • Family advised to attend without delay to the nearest hospital either D&GRI or GCH.  Families with children well enough to travel by car should present directly to the Children’s Ward if attending D&GRI and otherwise GCH Emergency Department (ED).  If parents are travelling via ambulance advise to attend ED.
  • Staff member taking the call is responsible for identifying and informing staff required for assessment or contacting GCH ED to inform them of expected arrival, highlighting the emergency process and signposting to the guidelines.
  • Prepare ahead of arrival for insertion of gripper, bloods and administration of antibiotics. Ensure patient is admitted promptly to Topas and Hepma.
  • Gripper needle list is kept in the Telephone Triage folder, parents should attend with correct needle.

Assessment

  • Nursing assessment within 15 minutes of arrival, ideally joint nursing and medical assessment will be more efficient.
  • Keep history brief.
  • Assess if they require resuscitation, are they septic or shocked?
  • Is there an obvious focus for infection?

Investigations

  • Bloods PRIOR to antibiotics: Culture from central line (preferred and priority, peripheral if no central line or not possible)

followed by FBC,CRP,U&E,LFT, if unwell coagulation screen and gas.

  • Other samples: viral & bacterial throat swabs, urine culture.
  • Consider CXR if respiratory signs (do not delay treatment for this).

Treatment

  • A DELAY IN ADMINISTERING THE FIRST DOSE OF ANTIBIOTICS MAY PROVE FATAL
  • Antibiotics should be given within 60 minutes of arrival.
  • The first dose of antibiotics may precipitate shock, be prepared to resuscitate.
  • First line antibiotics: Tazocin (90mg/kg/dose 4 times a day) plus Gentamicin (7mg/kg/once daily)
  • Patients with known serious penicillin allergy should have an individualised plan (usually Ciprofloxacin and Vancomycin).
  • Patients known to be non-neutropenic, or are not expected to be neutropenic and considered low-risk for developing severe sepsis may be treated first line with single agent Tazocin.

On-going management

  • Patients started on both Tazocin and Gentamicin who are found not to be neutropenic should stop Gentamicin if neither septic nor shocked after consultation with Schiehallion.
  • Schiehallion should be notified of all Haematology/Oncology admissions and provide daily updates with blood results and progress update Tel : 0141 451 5645 (medical office).
  • Patients who remain febrile after 72 hours should be considered for second line antibiotics Meropenem, on discussion with Schiehallion.
  • Patients with suspected line central line infection should be discussed with Schiehallion regarding consideration of Teicoplanin and use of line.

For further GGC guidance see link:

Management of neutropenia & fever: antibiotic policy (scot.nhs.uk)