Febrile Neutropenia — an oncologic emergency in immunocompromised children:

Definition:

• Fever: single temperature \(\geq 38.3°C\) OR \(\geq 38°C\) sustained for \(\geq 1\) hour
• Neutropenia: ANC \(<500\,\text{cells/}\mu\text{L}\) OR ANC \(<1000\,\text{cells/}\mu\text{L}\) expected to fall below 500

This child: Temp 38.6°C + ANC 450 = Febrile Neutropenia

Time is critical: Mortality increases significantly if antibiotics delayed >60 minutes.

Management protocol:

1. Blood cultures (peripheral × 2 + from each lumen of central line) BEFORE antibiotics
2. Urine culture, CXR if respiratory symptoms
3. CBC, CMP, LFTs
4. IV broad-spectrum antibiotics within 60 minutes: Piperacillin-tazobactam OR cefepime OR meropenem (if high-risk/unstable)
5. Add vancomycin if: MRSA risk, central line infection, hemodynamic instability
6. Protective isolation (reverse isolation/HEPA room)

Protective isolation precautions:

• No fresh flowers/plants, no fresh fruits/vegetables (raw)
• Strict hand hygiene
• Avoid contact with sick visitors
• HEPA-filtered room for ANC <200