Risk Prediction of Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia

Abstract

Background: Fever in severe chemotherapy induced neutropenic patients is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimen. Objective: The aim of this study is identification of risk factors of fever in neutropenic children with acute lymphoblastic leukemia. Methodology: This observational study was carried out in the department of pediatric haematology and oncology department during the period of 1st February 2013 to 31st January 2014. Patients detailed history and behavioral pattern regarding the supportive management (neutropenic diet, use of acriflavine solution, nystatin oral solution, mouth wash with povidone iodine), total duration of hospital stay, duration of neutropenia, number of attendants during hospital stay were recorded. Blood, urine and wound swab culture was done. Result: Out of 40 patients most of the studied child were in induction phase of therapy. The mean hospital stay was 8.56±6.75 days and mean number of attendants with each patient was 2.02±0.65. Majority of the patient were on neutropenic diet and freshly cooked food (87.5%). This study shows a large portion (52.5%) of the studied population did not use acriflavine as per advice. It also revealed majority of the child did not use povidone iodine mouth wash (52.5%) and nystatin (47.5%). as per advice. A total of 10 patients (25%) revealed growth of pathogens. Among them blood culture was positive in 4 patients, urine culture was positive in 3 patients and wound swab culture was positive in 3 patients. This study showed that major portion (65%) of the febrile neutropenic child suffered from malnutrition. Conclusion: This study showed that majority of the patient did not properly follow the advice regarding behavioral and supportive management. Duration of hospital stay and number of attendants were also high. Malnutrition was present in a large portion of the child.