The Outcomes of Pediatric, Adolescent, and Young Adult Oncology Patients With Non-neutropenic Fever: A Scoping Review of the Literature

Background: There are established and well-followed guidelines for pediatric oncology patients who have neutropenic fever. However, there are no explicit criteria for this patient group, and over 50% of pediatric oncology patients with fever do not present with neutropenia.

Objective: In this scoping review, we have explored the outcomes of non-neutropenic fever in pediatric, adolescent, and young adult patients with cancer-directed treatment. The results of this scoping review should assist in the creation of a guideline for the management of non-neutropenic fever in this group of patients.

Method: Multiple electronic databases and reference lists were searched (PubMed, MEDLINE CENTRAL, and Google (first 100 results only)). Included are retrospective and prospective cohort studies on the management and outcome of pediatric oncology patients with non-neutropenic fever that have been published after the year 2000.

Results: Seventeen studies with a total of 10.845 fever episodes were included, that address the treatment and outcome of patients with non-neutropenic fever. The rate of bacteremia was 1.6 - 14.4% (mean 5.8%). The mortality rate was low due to non-bacterial causes. Across different studies, proposed risk factors for bacteremia were higher temperature, prolonged fever over 72 hours, ill-appearing patients, chills, hypotension, leukocytosis, infancy, and the presence of a Broivac/ Hickman catheter. Limitations to this study are the risk of bias, and potential incomplete identification of relevant studies pertinent to the research questions asked.

Conclusion: Due to significant heterogeneity, the published data so far are not sufficient to propose evidence-based guidelines for pediatric oncology patients with non-neutropenic fever. Prospective, multicenter registries based on uniform definitions are needed. No funding was received for this manuscript.