Evaluation and treatment of fever in the non-neutropenic child with cancer

Wanda Salzer, Seth M. Steinberg, David J. Liewehr, Alison Freifeld, Frank M. Balis, Brigitte C. Widemann

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose: To document the current approach to the evaluation and treatment of febrile non-neutropenic children with cancer by surveying American Society of Pediatric Hematology/Oncology (ASPHO) members. Methods: Five hundred ninety-five ASPHO members were sent questionnaires polling their current practices in the evaluation and treatment of clinically stable, febrile (oral temperature of 38°C x2, or ≥38.3°C), non-neutropenic (absolute neutrophil count >500/μL) pediatric cancer patients who have no identifiable bacterial infection. Patients were assigned to one of four groups based on the presence or absence of a central venous catheter (CVC) and no source (NS) or presumed viral source (VS) for fever. Results: Three hundred sixteen ASPHO members (53%) responded and 300 questionnaires were evaluable. If a CVC was present, respondents universally drew blood cultures (99% NS, 96% VS) from the CVC, but only one third drew peripheral blood cultures (33% NS, 29% VS). If a CVC was not present, the majority of respondents (80% NS, 61% VS) drew peripheral cultures. ASPHO members started empiric antibiotics more frequently in patients with a CVC (69% NS, 55% VS) than in patients without a CVC (33% NS, 23% VS). Most did not admit these patients to the hospital (40% CVC and NS, 33% CVC and VS, 22% no CVC and NS, 19% no CVC and VS). ASPHO members with more years of experience were more likely to obtain peripheral blood cultures if a CVC was present and to admit a patient without a CVC. Conclusions: Nearly all respondents obtained a blood culture from the CVC in the initial assessment of the febrile, non-neutropenic patient with a CVC, but other evaluation and management practices varied considerably.

Original languageEnglish (US)
Pages (from-to)606-612
Number of pages7
JournalJournal of Pediatric Hematology/Oncology
Issue number8
StatePublished - Aug 2003


  • Cancer
  • Children
  • Fever
  • Non-neutropenia
  • Treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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