Arthrotomy and Lavage of Neonatal Septic Arthritis - A Multicenteric Study

Abstract

Background: Acute septic arthritis (SA) of childhood is a potentially devastating disease that may cause permanent disability or even death, especially in resource - limited settings. Septic arthritis is rare in developed countries, the annual incidence being 4 cases p er 1,00,000 but is considerably more common in lower socioeconomic groups. Objective: To study about the septic arthritis in neonates using arthrotomy & lavage and the complications associated with septic arthritis. Materials and Methods : A total of 319 n eonates with septic arthritis irrespective of the joint involved, admitted to NICU in School of Medical Sciences and Research , Madras Medical College and Mohan Kumaramangalam Medical College for a period of three consecutive years were taken up for the stu dy. All suspected cases of neonatal septic arthritis were subjected for detailed clinical history, examination, hematological and radiological investigations were done. All suspected cases were started with empirical or culture specific IV antibiotics for 2 weeks. The neonates who responded to the treatment given within 48 – 72 hours were treated conservatively and excluded from our study. The neonates who did not respond to the antibiotics given were subjected for arthrotomy and lavage of the affected join t. The aspirated material was sent for culture and sensitivity for specific antibiotic treatment. The treatment was given with culture specific IV antibiotics for a minimum period of 2 weeks followed by oral antibiotics for a period of 2 weeks from the tim e symptoms subsides. All cases were followed up at a monthly interval to a minimum period of 1 year of their age. Results: A total of 512 septic arthritis cases were seen in infants of whom 319 cases were neonates during the three year study period. The m ost common organism causing neonatal septic arthritis in our study was Staphylococcus aureus in 116 cases (36.36%). No organism was cultured in 81 cases (25.39%). Viral or fungal or anaerobes or reactive arthritis might be responsible for this 25.39% cases . Concomitant osteomyelitis was found in 5 cases in hip % 1 case in knee. Tomsmith arthritis of hip was found in 2 cases. Mild joint stiffness were found in 7 cases in hip, 3 cases in knee, 1 case in shoulder and 1 case in ankle seen at follow up. After di scharge gentle passive joint motion were advised. The missed cases from follow up were not included in the study. Conclusion: The sequelae of septic arthritis in neonates can be prevented by early diagnosis and early intervention with emergency lavage of any involved joint to reduce the rate of disability. The arthrotomy and lavage is the definitive treatment for neonatal septic arthritis which reduce the morbidity and mortality of the neonates.