title: Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation.
abstract: OBJECTIVE
  To develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN).
  
  
  METHODS
  The International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations.
  
  
  RESULTS
  Recommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented.
  
  
  CONCLUSIONS
  This guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context.
authors.affiliation: Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehrnbecher
authors.forename: Robert
authors.initials: R
authors.lastname: Phillips
authors.forename: Sarah
authors.initials: S
authors.lastname: Alexander
authors.forename: Frank
authors.initials: F
authors.lastname: Alvaro
authors.forename: Fabianne
authors.initials: F
authors.lastname: Carlesse
authors.forename: Brian
authors.initials: B
authors.lastname: Fisher
authors.forename: Hana
authors.initials: H
authors.lastname: Hakim
authors.forename: Maria
authors.initials: M
authors.lastname: Santolaya
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Davis
authors.forename: L Lee
authors.initials: LL
authors.lastname: Dupuis
authors.forename: Faith
authors.initials: F
authors.lastname: Gibson
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Groll
authors.forename: Aditya
authors.initials: A
authors.lastname: Gaur
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.forename: Rejin
authors.initials: R
authors.lastname: Kebudi
authors.forename: Sérgio
authors.initials: S
authors.lastname: Petrilli
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.forename: Milena
authors.initials: M
authors.lastname: Villarroel
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005334:Fever / Q000175:diagnosis* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000175:diagnosis* / Q000628:therapy*