Background: Neutropenia may alarm clinicians and prompt extensive evaluation in children
with fever, even in immunocompetent patients. Objective: To determine outcomes in previously
healthy febrile children presenting to the emergency department with severe neutropenia.
Methods: We reviewed data from infants and children with fever and severe neutropenia,
defined as a peripheral neutrophil count <500x103/μL, at our institution from January 1st 2012
and December 31st 2015. We compared our results to those from a similar study of children with
a peripheral neutrophil count of 500-1000x103/μL. Results: Severe neutropenia was recorded in
52 patients (ages 3 months-36 months), SBI was found in 4 (7.6%) but none had a positive blood
culture. Incidence of SBI was not different from that found in a similar study of patients with
moderate neutropenia. Conclusion: 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.
