Background: Neutropenic fever is a definite side effect of intensive chemotherapy. It is essential to initiate rapid and effective treatment for febrile neutropenia. Restoring the adrenal reserve and maintaining its anti-inflammatory role is one of the treatment goals. Objective: to Study the benefit of adding hydrocortisone to cancer children with high -risk neutropenic fever and its effect on duration of hospitalization, clinical status, and patients’ outcome. Patients and methods: An interventional single blind randomized controlled study including 50 pediatric cancer patients. Patients were randomized into a standard group (A) following the standard of care for management of high -risk febrile neutropenia and interventional group (B) using hydrocortisone infusion in the first 48h of febrile neutropenia as an adjuvant therapy. Results: Neutropenic fever period and hospital admission days were shorter in group B than group A ( p =0.052 and 0.005 respectively). The need to change the empiric antibiotic was less for group B than group A ( p = 0.024). Systolic blood pressure was higher in group B than group A ( p = 0.040). Conclusion: The use of hydrocortisone was associated with shorter duration of neutropenic fever and hospital stay, less need for second line antibiotics and protective against hemodynamic instability.