What are the causes of neutropenia in a 12-month-old child?

From the Guidelines

Neutropenia in a 12-month-old requires immediate medical attention to prevent serious infections, and parents should contact their pediatrician or go to the emergency department without delay. The normal neutrophil count for a child of this age is typically above 1,500 cells/μL, with neutropenia defined as counts below this threshold 1. Key considerations include:

• The severity of neutropenia, which can range from mild (1,000-1,500 cells/μL) to severe (below 500 cells/μL), with the latter often necessitating hospitalization.
• Common causes in infants, such as viral infections, certain medications, autoimmune disorders, or rarely, congenital conditions.
• Management strategies, which depend on the severity and cause, and can include observation with close monitoring for mild cases, or more aggressive treatments like antibiotics (e.g., cefepime or piperacillin-tazobactam) for febrile neutropenia, and possibly granulocyte colony-stimulating factor (G-CSF) to stimulate neutrophil production.

While awaiting medical care, it is crucial to minimize the risk of infection by:

• Practicing good hand hygiene
• Avoiding crowds and sick contacts
• Monitoring for fever (temperature ≥100.4°F/38°C), which requires immediate medical attention in a neutropenic child, as indicated by guidelines for managing fever and neutropenia in pediatric patients 1.

From the FDA Drug Label

In a phase 3 study (Study 7) to assess the safety and efficacy of filgrastim in the treatment of SCN, 123 patients with a median age of 12 years (range 7 months to 76 years) were studied. Of the 123 patients, 12 were infants (7 months to 2 years of age), 49 were children (2 to 12 years of age), and 9 were adolescents (12 to 16 years of age) Pediatric patients with congenital types of neutropenia (Kostmann’s syndrome, congenital agranulocytosis, or Schwachman-Diamond syndrome) have developed cytogenetic abnormalities and have undergone transformation to MDS and AML while receiving chronic filgrastim treatment The safety and effectiveness of ZARXIO have been established in pediatric patients with SCN [see Clinical Studies (14. 5)].

The use of filgrastim in pediatric patients, including those with neutropenia, has been studied. Key points include:

• Pediatric use: Filgrastim has been used in pediatric patients as young as 7 months old.
• Safety and effectiveness: The safety and effectiveness of filgrastim have been established in pediatric patients with Severe Chronic Neutropenia (SCN).
• Adverse effects: Pediatric patients with congenital types of neutropenia have developed cytogenetic abnormalities and undergone transformation to MDS and AML while receiving chronic filgrastim treatment, although the relationship to filgrastim is unknown 2.

From the Research

Neutropenia in a 12-month-old

• Neutropenia is a condition characterized by an abnormally low count of neutrophils, a type of white blood cell that plays a crucial role in fighting infections 3.
• The causes of neutropenia can be diverse, including genetic disorders, autoimmune diseases, and certain medications such as antibiotics 3.
• In the case of a 12-month-old child, it is essential to identify the underlying cause of neutropenia to provide appropriate treatment and management.

Treatment and Management

• Granulocyte-colony stimulating factor (G-CSF) is a medication that can be used to stimulate the production of neutrophils in patients with neutropenia 4, 5.
• G-CSF has been shown to be effective in reducing the duration and severity of neutropenia, as well as the risk of infections and other complications 4, 5.
• However, the use of G-CSF in certain situations, such as in cancer patients with COVID-19, may need to be carefully considered due to potential risks and benefits 6.

Diagnosis and Assessment

• The diagnosis of neutropenia typically involves a complete blood count (CBC) to determine the absolute neutrophil count (ANC) 3.
• Imaging analysis systems, such as those used in the assessment of urinary bladder carcinomas, may also be useful in evaluating the severity of neutropenia and guiding treatment decisions 7.
• However, it is essential to note that the study on urinary bladder carcinomas may not be directly relevant to the diagnosis and management of neutropenia in a 12-month-old child.