# POL-CW-01 — Management of febrile neutropenia

**Riverside Children's Cancer Centre — Cedar Ward**
**Owner:** Infectious Diseases (Dr A. Rahman)
**Version:** 3.1
**Date:** 12 March 2024
**Review due:** 12 March 2026
**Applies to:** inpatients and outpatients aged 0–18 years on Cedar Ward
**Status:** current — teaching copy, not a real hospital policy

## 1. Purpose

To make sure a child with fever during neutropenia is assessed at once, cultured, and given the first dose of antibiotic without delay.

## 2. Definitions

- **Fever:** a single oral or axillary temperature of 38.3°C or higher, or a temperature of 38.0°C or higher lasting one hour.
- **Neutropenia:** absolute neutrophil count (ANC) below 500/µL. Do not wait for the ANC if the child is on chemotherapy and looks unwell — treat as febrile neutropenia until the count is back.
- **High-risk:** AML, infant ALL, allogeneic transplant in the last 100 days, or any child with a central line and shock.

## 3. Immediate action

Families must bring the child to the Emergency Department **the same evening**. Do not wait for clinic in the morning. Do not give paracetamol at home to “see if the fever settles” before the child is seen.

Door-to-antibiotic time is **60 minutes** from arrival. Cultures first, then the first dose. Never reverse that order.

## 4. Cultures and first-line drugs

Draw a peripheral blood culture and a culture from every lumen of a central line **before** antibiotics. Draw the peripheral culture first.

First-line antibiotic for Cedar Ward:

- Piperacillin-tazobactam 100 mg/kg (piperacillin component) IV every 6 hours.
- Add gentamicin 7 mg/kg once daily if the child is high-risk.

If the child has a documented penicillin rash, use cefepime 50 mg/kg IV every 8 hours instead. Do not use ceftriaxone as first-line for febrile neutropenia on this ward.

## 5. Central lines

Antibiotics may run through the central line after cultures have been drawn. Do not lock the line with heparin as part of this pathway — follow POL-CW-02 for line care.

## 6. Visitors during neutropenia

While ANC is below 500/µL, **no visitors** other than two named caregivers. No children under 12. See POL-CW-03.

## 7. Family education

The discharge leaflet (POL-CW-05) must tell families: fever during neutropenia is an emergency; come to ER the same evening; do not give an antipyretic before the child is assessed.

## 8. Related documents

- POL-CW-02 Central venous access devices
- POL-CW-03 Visitor and protective isolation
- POL-CW-05 Discharge and after-hours fever advice