Category | Condition | Predominant causes of fever | Initial management |
Low risk | - Transient isolated neutropenia in otherwise healthy child
| Viral infection | - Appropriate treatment for age or site of localized infection
- Careful follow-up
- Serial blood counts to ensure that neutropenia resolves
|
- Chronic autoimmune neutropenia/chronic idiopathic neutropenia
| Common: - Upper respiratory tract infections
- Acute otitis media
- Skin infections
- Gingivitis
- Mouth ulcers
| - Oral antibiotics as indicated for suspected bacterial infections and close outpatient follow-up for patients with adequate bone marrow reserves for most common infections
- Skin and soft tissue infections generally warrant hospitalization and parenteral antibiotics
|
Less common: - Pneumonia
- Periorbital cellulitis
- Labial cellulitis or abscess in females
- Meningitis
- Sepsis
| - Hospitalization and parenteral antibiotics for complicated febrile illnesses*
- Individualized management for children with history of complicated febrile illness*
|
Low-moderate risk | | Common: - Oral ulcers
- Gingivitis
- Periodontitis
- Pharyngitis
- Adenopathy
| - Generally do not require antibiotics for fevers or mucocutaneous inflammatory lesions that are typical during neutrophil nadirs
|
Less common: - Bacteremia
- Cellulitis
- Acute otitis media
- Sinusitis
- Pneumonia
- Peritonitis
| - Individualized management for:
- Atypical fevers or lesions
- Less common localized infections (eg, cellulitis, acute otitis media, sinusitis, pneumonia, peritonitis)
- Children with a history of complicated febrile illness*
|
Uncommon: - Clostridium-associated necrotizing enterocolitis
| - Hospitalization and broad-spectrum parenteral antibiotics for:
- Abdominal pain
- Significant localized infection
- Signs of sepsis
|
High risk | - Severe congenital neutropenia
| - Omphalitis
- Cellulitis
- Perirectal abscess
- Sepsis
| - Hospitalization and initiation of broad-spectrum antibiotics
|
- Aplastic anemia, including inherited forms:
- Shwachman-Diamond syndrome
- Fanconi anemia
- Dyskeratosis congenita
| - Dyskeratosis congenita
- Soft tissue infections
- Bacteremia
- Invasive fungal disease, especially due to Aspergillus spp
| - Hospitalization and initiation of broad-spectrum antibiotics
- Antifungal agents may be warranted for persistent unexplained fever
|
- Ill-appearing child with neutropenia
| - Cellulitis
- Perirectal abscess
- Sepsis
- Respiratory tract infections
- Bacteremia
- Invasive fungal disease, especially due to Aspergillus spp
| - Hospitalization and initiation of broad-spectrum antibiotics
- Antifungal agents may be warranted for persistent unexplained fever
|