Aquino V M, Buchanan G R, Tkaczewski I, Mustafa M M
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Med Pediatr Oncol. 1997 Mar;28(3):191-5. doi: 10.1002/(sici)1096-911x(199703)28:3<191::aid-mpo7>3.0.co;2-e.
The safety of early hospital discharge (i.e., before the absolute neutrophil count [ANC] exceeds 500 cell/mm3) of febrile neutropenic children and adolescents with cancer who had experienced prolonged neutropenia (i.e., for more than 7 days) following admission has not been studied.
Three hundred and thirty nine consecutive admissions of children and adolescents with cancer for management of febrile neutropenia were reviewed. Early discharge criteria included absence of fever for 24 hours prior to discharge, sterile blood cultures for 24 hours, evidence of bone marrow recovery defined as a sustained increase in platelet count and ANC or absolute phagocyte count (APC), and control of local infection if present. Children hospitalized with febrile neutropenia who remained neutropenic for more than 7 days were analyzed to assess their outcomes following discharge it they had met criteria for early hospital discharge.
Thirty-three patients in whom neutropenia had persisted for more than 7 days were discharged before attaining an ANC greater than 500/mm3 when they met the early discharge criteria. Only two children (6%) required readmission for recurrent fever, a rate which was not different from that of patients discharged after a more transient episode of neutropenia (2 of 33 vs. 3 of 121, P = 0.3). Both patients who were readmitted had a source of local infection which worsened despite oral antibiotics. Both patients appeared clinically well at the time of readmission and had sterile cultures during their second hospitalization with resolution of local infection.
This study confirms that low-risk criteria used to select children with cancer for discharge before complete resolution of neutropenia can be safely applied to those patients whose neutropenia lasted more than 7 days following admission.
对于入院后经历长期中性粒细胞减少（即超过7天）的发热性中性粒细胞减少症癌症儿童和青少年，早期出院（即在绝对中性粒细胞计数[ANC]超过500个细胞/mm³之前）的安全性尚未得到研究。
回顾了339例因发热性中性粒细胞减少症接受治疗的癌症儿童和青少年的连续入院病例。早期出院标准包括出院前24小时无发热、血培养24小时无菌、骨髓恢复的证据，定义为血小板计数、ANC或绝对吞噬细胞计数（APC）持续增加，以及如有局部感染则得到控制。对因发热性中性粒细胞减少症住院且中性粒细胞减少持续超过7天的儿童进行分析，以评估他们在符合早期出院标准后出院的结局。
33例中性粒细胞减少持续超过7天的患者在符合早期出院标准但ANC未达到大于500/mm³时出院。只有两名儿童（6%）因反复发热需要再次入院，这一比例与中性粒细胞减少发作较短暂后出院的患者相同（33例中的2例与121例中的3例，P = 0.3）。两名再次入院的患者均有局部感染源，尽管使用了口服抗生素，感染仍恶化。两名患者在再次入院时临床状况良好，第二次住院期间血培养无菌，局部感染得到缓解。
本研究证实，用于选择癌症儿童在中性粒细胞减少完全缓解前出院的低风险标准可安全应用于入院后中性粒细胞减少持续超过7天的患者。
