Optimizing Care for Neutropenic Fever in Pediatric Patients: An Analysis of Treatment Approaches and Clinical Outcomes.

Abstract

Introduction: Febrile neutropenia is a serious complication in pediatric oncology. Kaiser Permanente Northern California hospitals use varying fever thresholds for admission criteria: the Kaiser Permanente Oakland hospital employs a threshold of 101.5 °F, and Kaiser Permanente Roseville and Kaiser Permanente Santa Clara use lower thresholds. This study aims to assess the potential risks associated with adopting different fever thresholds, including bacteremia, pediatric intensive care unit (PICU) transfer, septic shock, and length of hospital stay.

Methods: This retrospective cohort study includes Kaiser Permanente Northern California members aged 1 to 18 years with an oncologic diagnosis admitted to 1 of 3 Kaiser Permanente Northern California hospitals with neutropenic fever between 2016 and 2022. Patients admitted with a fever ≥ 101.5 °F (high-temperature group) were compared to those admitted with a fever < 101.5 °F (low-temperature group).

Results: The study cohort included 177 patients with a mean age of 8.2 ± 5.4 years, 59.3% male. Of these patients, 70 (39.6%) were in the low-temperature group, and 107 (60.5%) were in the high-temperature group. Overall, 24 (13.6%) patients developed bacteremia, and 24 (13.6%) required PICU transfer. Comparisons between the low- and high-temperature groups showed no statistically significant differences in rates of bacteremia (8.6% vs 16.8%, P = .12), PICU transfer (12.9% vs 14.0%, P = .83), septic shock (2.9% vs 4.7%, P = .71), or length of hospital stay (4.5 [interquartile range 2.5-8.4] vs 4.2 [interquartile range 2.6-8.1] days, P = .98).

Discussion and conclusion: Future studies with larger sample sizes are needed to validate these findings. Similar studies evaluating outcomes based on admitting temperature can shed light on the most appropriate fever threshold for admission to optimize outcomes for pediatric oncology patients.