Neonatal Osteomyelitis Research Articles

Pediatric Osteomyelitis Masquerading As Skeletal Neoplasia

Osteomyelitis has many forms of presentation in the pediatric age group. From neonatal osteomyelitis, with a paucity of clinical symptoms and signs, to the more typical acute hematogenous form or even the subacute or chronic presentations, a high index of suspicion is needed to institute appropriate investigations and treatment.

Pediatric Hematogenous Osteomyelitis: New Trends in Presentation, Diagnosis, and Treatment.

The character of acute hematogenous osteomyelitis (AHO) in North American children has changed significantly during the past several decades. Although the typical clinical picture of established acute osteomyelitis in children (illness, dehydration, and an acutely painful limb) is still seen, more subtle presentations appear more frequently. Children often present with subacute osteomyelitis. Less common variants include Brodie's abscess, subacute epiphyseal osteomyelitis, and chronic recurrent multifocal osteomyelitis. Some patients present with a bone lesion that may be confused with other disease entities, including neoplasms. Biopsy is often needed to clarify the diagnosis. With the trend toward more invasive procedures in the neonatal intensive care unit, neonatal osteomyelitis is also seen more frequently. Advances in imaging technology, particularly improvements in technetium bone scanning and the advent of magnetic resonance imaging, have contributed to more precise diagnosis and better management of AHO. With the increased concern about medical economics, the recent trend toward decreasing the duration of intravenous antibiotic treatment of these infections appears to be appropriate as long as certain criteria are met. Neither surgery nor antibiotics alone will be associated with successful treatment in all cases, and this fact may explain the rare but continued morbidity that is still seen in children with AHO.

Neonatal osteomyelitis in Down's syndrome due to non-encapsulated Haemophilus influenzae

A case of neonatal osteomyelitis in a baby with Down's syndrome is described. The causative organism was a non-encapsulated Haemophilus influenzae biotype I, which was isolated from pus at the site of infection. This organism has not previously been reported as a cause of neonatal osteomyelitis.

Short humerus: results of 11 prolongations in 10 children and adolescents

The author evaluates the results of extension of 11 humeri in 10 children and adolescents with an average age of 12.5 years. The most frequent cause of the abbreviation was neonatal osteomyelitis. A Wagner apparatus was used with success and is considered highly suitable for this purpose. The maximum extension was 95 mm; one bone was extended twice with an interval of 2 years in between. The most serious complication was temporary paralysis of the nerves of the forearm and hand. Correction of the length of the upper extremities has a positive effect on the patient's psyche and on the aesthetic appearance and the functioning of the limb.

Acute osteomyelitis and septic arthritis in children: a spectrum of disease

A spectrum of acute osteomyelitis and septic arthritis seen in children was studied, identifying four major groups, each with a different clinical presentation and different expected prognosis: (1) the usual group of osteomyelitis with a 10% incidence of poor results; (2) neonatal osteomyelitis (10% of osteomyelitis) with 25% poor results; (3) a group of severely ill patients with disseminated staphylococcal disease (10% of osteomyelitis) with 13% mortality and 38% poor results; and (4) the usual group of septic arthritis, with 5% poor results. Almost all cases of osteomyelitis were due to Staphylococcus aureus except in the neonatal group, where 28% were due to β-haemolytic streptococci. Surgical drainage was performed in 91% of the usual osteomyelitis cases, in all with disseminated staphylococcal disease, and in 88% of babies with neonatal osteomyelitis, i.e. all the cases involving a joint. Cloxacillin was the drug of choice in osteomyelitis. In septic arthritis Staph. aureus was cultured in 29%, Haemophilus influenzae in 18%, streptococcus in 12%, pneumococcus in 6%, and no growth in 33%. Open arthrotomy was performed in all cases. Cloxacillin was used for cases infected with Staph. aureus, ampicillin for H. influenzae, and penicillin for streptococcal and pneumococcal infections.

Infected cephalhaematoma and neonatal osteomyelitis

Neonatal osteomyelitis of the skull secondary to cephalhaematoma has been reported infrequently. The case reported here is that of a 7-week-old infant with a previously resolving cephalhaematoma who presented with cranial osteomyelitis. Cephalhaematomas should be considered potential sites of infection in any infant, even without a history of scalp trauma.

Neonatal Group B Streptococcal Osteomyelitis and Suppurative Arthritis

ORAL ANTIBIOTIC TREATMENT of acute staphylococcal osteomyelitis in toddler and school-age children has proven a cost-effective and efficacious alternative to intravenous therapy. 1,2 Oral antibiotic regimens, however, have not been carefully studied in neonatal osteomyelitis. We recently treated an infant with oral antibiotics for multifocal group B streptococcal (GBS) osteomyelitis and suppurative arthritis and report our experience.

Radionuclide Bone Scintigraphy in Pediatric Orthopedics

Radionuclide bone scintigraphy is highly sensitive and specific for diagnosing the musculoskeletal disorders of childhood. Conditions such as neonatal osteomyelitis, septic arthritis, diskitis of childhood, Legg-Calvé-Perthes disease, the osteochondroses, the "toddler's fracture," sports injuries, spondylolysis, myositis ossificians, and reflex sympathetic dystrophy are readily defined. High-quality state-of-the-art scintigraphy is essential in infants and young children.

Cephalhematoma Complicated by Osteomyelitis Presumed due to Gardnerella vaginalis

CEPHALHEMATOMA is a common condition in the neonate, reported to affect boys more commonly than girls and the right parietal bone more commonly than the left. 1 Neonatal osteomyelitis of the calvaria, on the other hand, is a relatively rare condition. 2-6 Gardnerella vaginalis is an organism of low virulence and invasiveness that is associated with nonspecific vaginitis. 7 The following case report describes a patient with cephalhematoma, right parietal osteomyelitis, a scalp aspirate revealing gram-negative pleomorphic rods, and a positive placental culture of gram-negative rods resembling G vaginalis . Report of a Case A male infant weighing 4080 g was born at 43 weeks' gestational age to a 17-year-old primigravida after induction of labor with oxytocin. External fetal heart monitoring showed cardiac rhythm irregularity, and accordingly an internal lead (scalp electrode) was inserted into the vertex. The infant was delivered vaginally under local anesthesia by low forceps after a prolonged

Neonatal Hematogenous Osteomyelitis

The findings in 40 infants with neonatal osteomyelitis were examined to evaluate factors that may predict the development of sequelae. On follow-up at 1-11 years of age, 16 children were found to have moderate (six) and severe (10) sequelae. Thirteen of these 16 children were among the 21 infants who had perinatal risk factors. On the other hand, there were only three handicapped infants in the group of 19 who had no risk factors. The high-risk infants were, on the average, younger at onset of osteomyelitis than the previously healthy babies. No differences were found between those two groups that could be ascribed to the causative organisms. Fifty-five osteomyelitic sites involving the large joints were diagnosed. Growth disturbance was evident in 20 of 36 nonoperated foci and four of 19 operated foci. To achieve the best result, the joint and abscess should be drained, and this should be supplemented by drainage of the metaphysis.

1082 NEONATAL OSTEOMYELITIS DUE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Neonatal osteomyelitis is rare. However, since the first isolation of methicillin-resistant Staphylococcus aureus 20 months ago in our nursery, we have diagnosed 4 cases of osteomyelitis due to methicillin-resistant Staphylococcus aureus. During this period we have encountered 8 infants with systemic disease, 2 infants with localized disease and 8 infants with colonization alone due to methicillin-resistant Staphylococcus aureus. Blood cultures were positive in 3 of 4 infants with osteomyelitis. Their mean birthweight was 1070 g and the mean gestational age was 29.6 weeks. Incidence of central line placement, need for multiple transfusions and prolonged total parenteral nutrition therapy indicate their complicated hospital course. The onset of the osteomyelitis was insidious and the early symptoms were non-specific. Multiple bones were involved in 2 infants, and 3 infants developed septic arthritis requiring surgical drainage. These infants were treated with vancomycin for 6-8 weeks. In contrast, the infants with colonization alone were larger, and has less complicated hospital courses. Our experience suggests that the infants developing systemic disease due to methicillin-resistant Staphylococcus aureus are similar to those acquiring Candida infection. However, unlike disseminated candidiasis significantly greater number of neonates with methicillin-resistant Staphylococcus aureus infection develop osteomyelitis.

Musculoskeletal Disorders in Neonatal Foals

Angular limb deformities are not uncommon in foals. Mild angular deviation due to laxity of supporting soft tissues often resolves spontaneously. However, external splinting or casting may be needed in severe cases or in those that do not resolve. When incomplete ossification of carpal or tarsal bones is the cause of the limb deformity, external support is mandatory to prevent further deformation and abnormal development of the bones. When epiphyseal and metaphyseal abnormalities cause axial deviation, surgical intervention is usually necessary. Circumferential periosteal transection and/or transphyseal bridging are methods used. The choice is dictated by the type and severity of the deformity. Flexor contractures of the forelimb vary greatly in degree and joints affected. Physical therapy combined with intermittent splint application is often successful, but surgical intervention may be necessary in unresponsive cases. Flexor tendon laxity is usually self-correcting but physical therapy, restricted exercise, and splinting may be needed. Rotational abnormalities are easier to correct in the forelimbs than in the hind limbs. Correction is usually accomplished by frequent corrective hoof trimming. Miscellaneous anomalies of the musculoskeletal system may sometimes be amenable to surgical correction, although the potential disadvantages must be carefully considered. Septic arthritis is a frequent sequela to neonatal septicemia and must be treated aggressively and early in its development. Appropriate systemic antibiotics, joint lavage, and rest are indicated. Neonatal osteomyelitis has a poor prognosis and requires prompt, vigorous therapy; even then, growth anomalies of the limb or contiguous septic arthritis may develop and further worsen the prognosis. Early accurate diagnosis and prompt appropriate therapy are vital in treating musculoskeletal disorders in foals, especially when a successful outcome is judged by the animal becoming a functional athlete.

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

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.

Treatment of neonatal osteomyelitis with cloxacillin in combination with fusidic acid.

Four immature infants developed staphylococcal neonatal osteomyelitis. In spite of standard treatment with cloxacillin, gentamicin and surgical drainage new lesions developed in all 4 patients. Following the addition of fusidic acid no further progress was seen in any of the infants. Fusidic acid was administered intravenously for 10-14 days in a dose of 40 mg/kg/day in 2 divided doses. The therapy was well tolerated. Thoracic kyphosis in one patient was the only sequelae seen.

NEONATAL OSTEOMYELITIS OF THE OS CALCIS

Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.

Neonatal Osteomyelitis of the Os Calcis

Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.

Neonatal osteomyelitis caused by Candida tropicalis. Report of two cases and review of the literature.

Neonatal osteomyelitis caused by Candida tropicalis. Report of two cases and review of the literature.

Osteomyelitis in a Neonatal Intensive Care Unit

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Neonatal Osteomyelitis Caused by Group B Streptococci

To the Editor.— McGuire and his colleagues (238:2054, 1977) are indeed correct that osteomyelitis caused by group B β-hemolytic streptococci (GBS) is rare. However, their assertion that there are only five reported cases of osteomyelitis from GBS in neonates is erroneous. There are three additional neonatal cases of osteomyelitis caused by GBS. 1-3 In one of these three cases, 1 GBS were also isolated from vaginal smears of the mother, whereas in the remaining two instances 2-3 GBS were not found in vaginal-cervical smears or in breast milk from the mothers five to six weeks after delivery.

Neonatal osteomyelitis caused by group B streptococci

Neonatal osteomyelitis caused by group B streptococci