Osteo-Articular Infections in Newborns: Diagnosis and Treatment

Abstract

Osteoarticular infections, although uncommon, represent a severe condition in neonates. Infections in newborns are largely of an acute nature, transmitted by hematogenous means. The most frequently observed etiological agents are: Staphylococcus aureus, Gram negative and group B Streptococcus spp. In the majority of cases the metaphyses of the long bone are the most commonly implicated sites, although infection may spread to the contiguous epiphysis and joint in neonates. Diagnosis of acute septic arthritis and osteomyelitis may be hindered, especially in neonates, due to the manifestation of less clear-cut characteristic symptoms and signs compared to in children. When osteomyelitis is suspected, imaging techniques used in association with blood and tissue cultures are the most reliable diagnostic tests. Antimicrobial treatment should be administered for 3-4 weeks, initially intravenously, later switching to oral medication. Surgery is indicated to drain acute abscesses or when no improvement is achieved following antibiotic treatment.

Osteoarthritis in the neonate: risk factors and outcome

“…AO caused by Gram-negative enteric bacilli is relatively uncommon despite the frequency of neonatal bacteremia. 19 In Stockholm, during 1969 to1979, E. coli and Klebsiella-Enterobacter were responsible for about 30% of neonatal septicemia, but only 5% of bone infections. 5 In contrast, S. aureus, although also causing about 30% of neonatal bacteremia, was responsible for 75% of osteomyelitis.…”

Neonatal Osteomyelitis

“…Risk factors for osteomyelitis and septic arthritis in preterm infants are mostly iatrogenic, including invasive procedures, intravenous or intra-arterial catheters, parenteral nutrition, ventilatory support, and bacteremia with nosocomial pathogens [11,12]. Two subgroups of neonates are affected: premature neonates with prolonged hospitalization and otherwise healthy newborns presenting within 2 to 4 weeks of discharge [13].…”

The Many Faces of Late Onset Group B Streptococcus Infection

“…The first case shows the best-case scenario for a GBS sepsis with a good outcome, while the third case shows an uncommon presentation of late onset GBS with osteomyelitis. Not only does osteomyelitis affect roughly only 0.2-1.6 out of 1,000 children annually, but Group B streptococcus is the but the third most prevalent bacteria found on culture in osteo-articular infections [6]. Our second case in particular shows a potential devastating outcome of late onset GBS disease.…”