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Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26711. Epub 2017 Jul 11.

A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients.

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Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Department of Neurology, University of Virginia, Charlottesville, Virginia.
Rady Children's Hospital, Peckham Center for Cancer and Blood Disorders, San Diego, California.
The Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York.
Department of Pediatrics, New York University School of Medicine, New York.
Pediatric Specialists of Virginia and Inova Fairfax Hospital, Virginia.
Children's Hospital of Nevada, Children's Specialty Center, Las Vegas, Nevada.



The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy.


Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t-test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a χ2 test.


One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%). There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% (P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone.


The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs.


chemotherapy; febrile neutropenia; infections in immunocompromised hosts; nutrition; pediatric hematology/oncology

[Indexed for MEDLINE]

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