Osteomyelitis in the neonate. Clinical aspects and the role of radiography and scintigraphy in diagnosis and management.

Abstract

Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal.

Neonatal Osteomyelitis

“…Neonates with osteomyelitis frequently show normal leukocyte counts and erythrocyte sedimentation rates in the first days. Thus, normal values do not preclude the diagnosis [30]. The C-reactive protein (CRP) is a rapid indicator of systemic inflammation and tissue damage, is useful as acute phase reactant, but not specific for skeletal infection.…”

Vertebral Complications of Late-Onset Neonatal Sepsis

“…По данным литературы [16,19,31], инфекционные поражения позво-ночника у детей первого года жизни встречаются крайне редко и не име-ют характерной клинической карти-ны до момента развития осложнений, что подтвердилось и в нашей клини-ческой серии: до появления кифоти-ческой деформации ни в одном слу-чае не диагностировали поражение позвоночника.…”

“…Наиболее частыми инфекцион-ными поражениями позвоночника у детей первых лет жизни считаются неспецифические спондилодисциты и туберкулезные спондилиты, кото-рые обычно проявляются умеренным болевым синдромом или осложне-ниями -деформацией позвоночни-ка или параличом [16,19,21,31]. При сепсисе новорожденных позвонки поражаются крайне редко, а описа-ние этой патологии, как правило, каса-ется деструкции одного-двух шейных позвонков [14,15,16,27,30,31].…”

Acquired bone dysplasia secondary to catheter-related complications in the neonate

“…Recent reports, however, show that high quality bone scintigraphy can be very accurate in diagnosing neonatal osteomyelitis [6]. Osteomyelitis of a multifocal variety with frequent joint involvement and severe residual skeletal deformities have been previously reported in high-risk, premature infants requiring umbilical artery catheterization [7] and in infants with longterm hyperalimentation [1,8]. Similar long bone changes have been reported recently in children post infantile meningococcemia with multiple irregular ball-and-socket deformities of the ends of long bones and cone-shaped epiphyses, probably secondary to embolization of epiphyseal vessels [9].…”