Abstract: Objectives To establish a contemporaneous symptom network that captures the multidimensional symptom experience of children receiving chemotherapy for acute leukemia and to explore the core symptoms and relationship among symptoms. Methods A total of 374 cases of pediatric acute leukemia admitted to hematology-oncology department of a tertiary hospital's from January 2021 to October 2022 were selected as the study subjects using convenient sampling. The occurrence and severity of symptoms were investigated using the Children's Memory Symptom Scale. A contemporaneous symptom network including 31 symptoms was constructed using the R package. The core symptoms and the relationship among symptoms were explored using network analysis. Results The network showed worrying (r_s=1.178, r_c=0.001, r_b=90.000) and feeling irritable (r_s=0.893, r_c=0.001, r_b=107.000) were the most central symptoms across three centrality indices including strength, closeness, and betweenness. Lack of energy is the most common symptom in children undergoing chemotherapy for acute leukemia, but it has lower central indices than other symptoms. The density of the induction remission network differed significantly from that of the consolidation strengthening and maintenance network (χ²=14.771,P<0.001). Conclusion Symptom network provides new empirical data for the precise nursing strategy in clinical practice. There is a need to assess centrality indices and network density as critical components of pediatric cancer care, especially for children in induction remission. Future studies must establish trajectories of dynamic symptom networks and centrality indices in longitudinal data to explore the causal relationships between symptoms and intervention markers.

Key words: children, acute leukemia, nursing, symptom management, network analysis