Clinical analysis of 17 cases of neonatal osteomyelitis

Abstract

Although acute osteomyelitis is rare in neonates, it might result in severe sequelae such as joint destruction and growth failure if it is not diagnosed and treated early. However, few studies have focused on the clinical features and treatment of this disease.A retrospective review of 17 cases of neonatal osteomyelitis, for which the patients underwent medical treatment alone or combined with surgery at the Children's Hospital of Zhejiang University School of Medicine between January 2009 and September 2016, was conducted. Medical treatment included the use of antibiotics and supportive care. Surgery was performed in cases with subperiosteal abscess (>1 cm) or clinical deterioration despite antibiotic therapy.All of the patients (11 men and 6 women) were term neonates. The main complaints were redness or swelling around the affected bone and fever. The most common sites were the femur (29.4%) and humerus (23.5%). There were 14 (82.35%) cases with positive cultures: Staphylococcus accounted for 71.43% (n = 10), followed by Salmonella (n = 1), Streptococcus pneumoniae (n = 1), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). X-rays (n = 14), ultrasound (n = 6), computed tomography (CT) (n = 5), or magnetic resonance imaging (MRI) (n = 7) were performed. Three of 14 x-rays were not pathological at the onset of the disease, while the positive rate of MRI in detecting osteomyelitis was 100%. Eleven of 17 cases underwent surgical drainage, and higher white blood cell (WBC) counts were found in patients requiring surgery (P < .05). The prognosis for all patients was good without severe sequelae with a mean follow-up period of 49.47 ± 23.43 months.In conclusion, the prognosis of neonatal osteomyelitis with early active treatment is good. MRI is advocated for detecting early osteomyelitis. Additionally, neonates with higher WBC count together with osteomyelitis have an increased risk for surgery.

Distal Tibia Epiphysiodesis After Saphenous Vein Catheterization During Treatment for Prematurity

“…The patient was a high-risk candidate for all complications associated with prematurity, such as primary bloodstream infection, pneumonia, meningitis, neurologic disease, etc [3,6]. On the other hand, according to published data, the risk for neonatal osteomyelitis (acute or HAI) is very low [6][7][8]. Furthermore, in neonates, osteomyelitis of the metaphysis quite frequently (up to 76% of cases) coexists with epiphysitis or septic arthritis, due to vascular communication of the metaphysis and the epiphysis in neonates [14,15].…”

“…These locations are considered the result of hematogenous spread and not of direct inoculation of microbes from the invasive procedure per se [ 7 ]. Zhan et al mention that, due to non-typical presentation at early stages, if not suspected by the clinician, diagnosis and treatment of neonatal osteomyelitis may be delayed [ 8 ]. Once again, the authors state that, neonate osteomyelitis is not very frequent.…”

“…Once again, the authors state that, neonate osteomyelitis is not very frequent. Its incidence is estimated at only 1-3 cases per 1000 hospital admissions per year [ 8 ],…”

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

“…In contrast, the outcome of shoulder joint infection is better [29,30]. Still, the easy extension into epiphyseal cartilage and concomitant septic arthritis in the shoulder joint warrants early surgical treatment for neonatal humeral osteomyelitis [31,32].…”

A Neonate with Amniotic Band Syndrome and Osteomyelitis

“…Osteomyelitis may become responsible for permanent sequelae in 6-50% like joint disabilities, change in bone growth due to the damage of the cartilaginous growth plate, limb length discrepancies, arthritis, pathologic fractures, and rarely complete destruction of joints. MRI has become the gold standard to evaluate musculoskeletal infection and the positive rate of MRI in detecting osteomyelitis was 100% (21). It has the capability of assessing the osseous, articular and muscular structures simultaneously and does not require ionizing radiation (18).…”