Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update
Thomas Lehrnbecher,Thomas Lehrnbecher,Paula D. Robinson,Brian T. Fisher,Brian T. Fisher,Sarah Alexander,Roland A. Ammann,Melissa Beauchemin,Fabianne Carlesse,Andreas H. Groll,Gabrielle M Haeusler,María Elena Santolaya,William J. Steinbach,Elio Castagnola,Elio Castagnola,Bonnie L. Davis,L. Lee Dupuis,Aditya H. Gaur,Wim J. E. Tissing,Theo Zaoutis,Theo Zaoutis,Robert S. Phillips,Lillian Sung +22 more
TLDR
Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation and future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.Abstract:
Purpose To update a clinical practice guideline (CPG) for the empirical management of fever and neutropenia (FN) in children with cancer and hematopoietic stem-cell transplantation recipients. Methods The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group of experts in pediatric oncology and infectious diseases that includes a patient advocate. For questions of risk stratification and evaluation, we updated systematic reviews of observational studies. For questions of therapy, we conducted a systematic review of randomized trials of any intervention applied for the empirical management of pediatric FN. The Grading of Recommendation Assessment, Development and Evaluation approach was used to make strong or weak recommendations and to classify levels of evidence as high, moderate, low, or very low. Results Recommendations related to initial presentation, ongoing management, and empirical antifungal therapy of pediatric FN were reviewed; the most substantial changes were related to empirical antifungal therapy. Key differences from our 2012 FN CPG included the listing of a fourth-generation cephalosporin for empirical therapy in high-risk FN, refinement of risk stratification to define patients with high-risk invasive fungal disease (IFD), changes in recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and a weak recommendation to withhold empirical antifungal therapy in IFD low-risk patients with prolonged FN. Conclusion Changes to the updated FN CPG recommendations will likely influence the care of pediatric patients with cancer and those undergoing hematopoietic stem-cell transplantation. Future work should focus on closing research gaps and on identifying ways to facilitate implementation and adaptation.read more
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Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
Scott L. Weiss,Mark J. Peters,Waleed Alhazzani,Michael S. D. Agus,Heidi R. Flori,David Inwald,Simon Nadel,Luregn J. Schlapbach,Robert C. Tasker,Andrew C. Argent,Joe Brierley,Joseph Carcillo,Enitan D. Carrol,Christopher L. Carroll,Ira M. Cheifetz,Karen Choong,Jeffry J. Cies,Andrea T. Cruz,Daniele De Luca,Daniele De Luca,Akash Deep,Saul N. Faust,Claudio Flauzino De Oliveira,Mark W. Hall,Paul Ishimine,Etienne Javouhey,Koen F. M. Joosten,Poonam Joshi,Oliver Karam,Martin C. J. Kneyber,Joris Lemson,Graeme MacLaren,Nilesh M. Mehta,Morten Hylander Møller,Christopher J. L. Newth,Trung C. Nguyen,Akira Nishisaki,Mark E. Nunnally,Margaret M. Parker,Raina Paul,Adrienne G. Randolph,Suchitra Ranjit,Lewis H. Romer,Halden F. Scott,Lyvonne N Tume,Judy T. Verger,Judy T. Verger,Eric A. Williams,Joshua Wolf,Hector R. Wong,Jerry J. Zimmerman,Niranjan Kissoon,Pierre Tissieres,Pierre Tissieres +53 more
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TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
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Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation
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TL;DR: This guideline represents an evidence-based approach to FN specific to children with cancer, and although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas.
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TL;DR: The data suggest that the patient with a fever of unknown origin who becomes afebrile during empiric antibiotic therapy may profit from continued therapy while granulocytopenia persists.
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