Outcomes of Immunocompetent Children Presenting with Fever and Neutropenia

Background: Neutropenia may alarm clinicians and prompt extensive evaluation in children with fever, even in immunocompetent patients. Objective: Our aim was to determine outcomes in previously healthy febrile children presenting to the emergency department with severe neutropenia. Methods: We reviewed data from infants and children aged 3–36 months with fever and severe neutropenia, defined as a peripheral neutrophil count <500 × 10³/μL, at our institution between January 1, 2012 and December 31, 2015. We compared our results to those from a similar study of children with a peripheral neutrophil count of 500–1000 × 10³/μL. Results: Severe neutropenia was recorded in 52 patients; severe bacterial infection (SBI) was found in 1 (1.9%), but none had a positive blood culture. Incidence of SBI was not different from that found in a study of similar patients with moderate neutropenia. Conclusions: Immunocompetent patients with fever and severe neutropenia do not carry a higher risk for SBI compared to patients with fever and moderate neutropenia. Such patients could potentially be followed closely with serial blood counts to ensure bone marrow recovery, without the use of antibiotics.