Malnutrition is a predisposing factor for developing recurrent fever following febrile neutropenia in children with acute lymphoblastic leukemia

Abstract

Introduction: The factors that predict recurrence of fever following defervescence (DS) during febrile neutropenia (FN) episode have not been studied. The objective was to estimate the incidence and risk factors for recurrent fever (RF) in children with FN during the intensive phase of acute lymphoblastic leukemia (ALL) treatment. Methods: The study included 113 consecutive patients diagnosed with ALL. Total of 256 FN episodes in these patients between January 2016 and June 2017 were analysed retrospectively. RF was defined as recurrent febrile event with absolute neutrophil count <500/mm3 that developed after an afebrile interval of 24 h but not exceeding 7 days following a febrile neutropenia episode. Results: RF developed in 38/256 FNE (14.85%). Evidence of documented focus of infection was observed in 26/38 RF. Risk factors associated with development of RF were: non-remission status of bone marrow, profound neutropenia, persistent neutropenia, clinically or microbiologically documented infection, severe underweight and documented weight loss. Multivariate analysis revealed significant association between RF and non-remission status of bone marrow, profound neutropenia and severe underweight. Conclusion: Severe underweight, profound neutropenia and non-remission status of bone marrow predispose the development of RF. These patients require close observation and may require prolonged administration of antibiotics irrespective of DS status.

Keywords

• Recurrent fever
• Childhood ALL
• Febrile neutropenia
• Severe underweight
• Profound neutropenia