•Agents of infection: bacteria, viruses, fungi

•In order to prevent infections, special precautionary measures need to be taken regarding hygiene, behavior, occupation, and nutrition. Guidelines vary depending on the clinic

Prophylactic Care

•Goal: protection of patients from infection by means of creation and maintenance of a clean environment and by good personal hygiene. Maintenance of best possible quality of life

•Reduction of fresh infections (strict disinfection of hands)

•Limitation of invasive procedures (e.g., few injections, avoidance of use of urinary catheter)

•Enhancement of immune defenses (e.g., immunoglobulins)

•Single bedroom, reverse isolation, positive-pressure rooms, HEPA-filtered air in special circumstances

Risk Factors

•Fever higher than 38.5°C (101°F) or persistent low-level fever, signs of cold (cough, sore throat, freezing or sweating, fatigue, weakness)

•Frequent or painful urination

•Injuries, wounds that will not heal, or that which turn red or swell

•Contact with other sick children

Treatment

•Treatment of infection:

–Antibiotic therapy needs to be initiated promptly at onset of first clinically suspicious signs and before culture and resistance results are available

–Antimycotics when appropriate

–Antiviral agents when appropriate

•Growth factors of myelopoiesis (especially after high-dose treatments and bone marrow transplantation), for example, granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage CSF (GM-CSF)

•Immunoglobulin infusion

•Nursing care including codes of conduct for nursing staff, patients, visitors, and the care itself are determined by clinic-specific guidelines

19.2.4.3Thrombocytopenia

Symptoms

•Bleedings occur as a consequence of too few platelets or decreased ability to clot blood normally

•The risk of spontaneous bleeding rises with decreasing number of platelets, particularly less than 20 × 109 per L

•Bleedings occur mainly in nasal and oral mucous membranes, intestines, skin, and central nervous system