Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya
IntroductionCompared to febrile neutropenia (FN), non-neutropenic fever (NNF) episodes in children with cancer have not been associated with severe outcomes. Risk factors for severe outcomes in FN and NNF episodes in children with cancer from low-middle-income countries (LMIC) are incompletely descr...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1575714/full |
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| author | Samuel Kipchumba Kenneth Busby Dennis Njenga Julia Dettinger Lenah Nyamusi Sandra Langat Sandra Langat Gilbert Olbara Cheryl A. Moyer Terry A. Vik Terry A. Vik C. Nathan Nessle C. Nathan Nessle Festus Njuguna |
| author_facet | Samuel Kipchumba Kenneth Busby Dennis Njenga Julia Dettinger Lenah Nyamusi Sandra Langat Sandra Langat Gilbert Olbara Cheryl A. Moyer Terry A. Vik Terry A. Vik C. Nathan Nessle C. Nathan Nessle Festus Njuguna |
| author_sort | Samuel Kipchumba |
| collection | DOAJ |
| description | IntroductionCompared to febrile neutropenia (FN), non-neutropenic fever (NNF) episodes in children with cancer have not been associated with severe outcomes. Risk factors for severe outcomes in FN and NNF episodes in children with cancer from low-middle-income countries (LMIC) are incompletely described.MethodsA prospective, observational cohort study was conducted at a tertiary public referral hospital in western Kenya. Inclusion criteria were age ≤14 years, cancer diagnosis, hospitalized, fever >38.5°C or persistently >38°C. Neutropenia was an absolute count (ANC) <500 K/µL. Severe outcomes were BSI or death. Statistical analysis detected significance between groups and a univariate analysis was conducted.ResultsOf the 99 fevers, 54.5% were NNF episodes. Over 66% of NNF episodes were in patients with solid tumors. More severe outcomes were observed in NNF episodes compared to FN [BSI: 7.4% (4/54) vs. 4.4% (2/45); death: 7.4% (4/54) vs. 4.4% (2/45)], yet no deaths occurred in episodes with BSI. Acute leukemia not in remission (OR= 8.67, 95% CI [CI: 2.3-32.62]; p= 0.002) and concern for disease relapse (OR= 14.17, 95% CI [2.08-96.3]; p= 0.012) were significantly associated severe outcomes. Time to antibiotic administration (9 hours) did not differ by ANC. Under half (45.5%) of fever episodes had a blood culture ordered, with 93.9% obtained after administration of antibiotics.DiscussionNon-neutropenic fever episodes had more severe outcomes. Prompt fever management is recommended in all children with cancer treated in an LMIC setting. Pediatric oncology treatment centers in LMICs should rigorously evaluate their fever management clinical practice. Clinical risk factors were identified, but a risk-stratified approach in an LMIC setting is not recommended. Urgent attention is needed to identify areas of clinical improvement. |
| format | Article |
| id | doaj-art-15b7cdc99838449bb1e66c5afb56eda6 |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-15b7cdc99838449bb1e66c5afb56eda62025-08-20T01:50:21ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.15757141575714Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in KenyaSamuel Kipchumba0Kenneth Busby1Dennis Njenga2Julia Dettinger3Lenah Nyamusi4Sandra Langat5Sandra Langat6Gilbert Olbara7Cheryl A. Moyer8Terry A. Vik9Terry A. Vik10C. Nathan Nessle11C. Nathan Nessle12Festus Njuguna13Department of Child Health and Pediatrics, Moi University, Eldoret, KenyaDepartment Pediatrics, Division Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United StatesAcademic Model for Providing Access to Healthcare, Eldoret, KenyaDepartment of Global Health, University of Washington, Seattle, WA, United StatesAcademic Model for Providing Access to Healthcare, Eldoret, KenyaAcademic Model for Providing Access to Healthcare, Eldoret, KenyaEmma Children’s Hospital of the Amsterdam University Medical Center (UMC), Vrije Universiteit, Amsterdam, NetherlandsMoi Teaching and Referral Hospital, Eldoret, KenyaDepartment of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United StatesAcademic Model for Providing Access to Healthcare, Eldoret, KenyaDepartment of Pediatrics, Division of Hematology-Oncology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United StatesDepartment of Pediatrics, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI, United States0Fogarty International Center, National Institute of Health, Bethesda, MD, United StatesDepartment of Child Health and Pediatrics, Moi University, Eldoret, KenyaIntroductionCompared to febrile neutropenia (FN), non-neutropenic fever (NNF) episodes in children with cancer have not been associated with severe outcomes. Risk factors for severe outcomes in FN and NNF episodes in children with cancer from low-middle-income countries (LMIC) are incompletely described.MethodsA prospective, observational cohort study was conducted at a tertiary public referral hospital in western Kenya. Inclusion criteria were age ≤14 years, cancer diagnosis, hospitalized, fever >38.5°C or persistently >38°C. Neutropenia was an absolute count (ANC) <500 K/µL. Severe outcomes were BSI or death. Statistical analysis detected significance between groups and a univariate analysis was conducted.ResultsOf the 99 fevers, 54.5% were NNF episodes. Over 66% of NNF episodes were in patients with solid tumors. More severe outcomes were observed in NNF episodes compared to FN [BSI: 7.4% (4/54) vs. 4.4% (2/45); death: 7.4% (4/54) vs. 4.4% (2/45)], yet no deaths occurred in episodes with BSI. Acute leukemia not in remission (OR= 8.67, 95% CI [CI: 2.3-32.62]; p= 0.002) and concern for disease relapse (OR= 14.17, 95% CI [2.08-96.3]; p= 0.012) were significantly associated severe outcomes. Time to antibiotic administration (9 hours) did not differ by ANC. Under half (45.5%) of fever episodes had a blood culture ordered, with 93.9% obtained after administration of antibiotics.DiscussionNon-neutropenic fever episodes had more severe outcomes. Prompt fever management is recommended in all children with cancer treated in an LMIC setting. Pediatric oncology treatment centers in LMICs should rigorously evaluate their fever management clinical practice. Clinical risk factors were identified, but a risk-stratified approach in an LMIC setting is not recommended. Urgent attention is needed to identify areas of clinical improvement.https://www.frontiersin.org/articles/10.3389/fonc.2025.1575714/fullsupportive carefebrile neutropeniapediatric oncologyAfricaimplementation scienceantibiotic |
| spellingShingle | Samuel Kipchumba Kenneth Busby Dennis Njenga Julia Dettinger Lenah Nyamusi Sandra Langat Sandra Langat Gilbert Olbara Cheryl A. Moyer Terry A. Vik Terry A. Vik C. Nathan Nessle C. Nathan Nessle Festus Njuguna Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya Frontiers in Oncology supportive care febrile neutropenia pediatric oncology Africa implementation science antibiotic |
| title | Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya |
| title_full | Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya |
| title_fullStr | Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya |
| title_full_unstemmed | Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya |
| title_short | Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya |
| title_sort | severe outcomes and risk factors of non neutropenic fever episodes in hospitalized children with cancer in kenya |
| topic | supportive care febrile neutropenia pediatric oncology Africa implementation science antibiotic |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1575714/full |
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