Clinical analysis of 17 cases of neonatal osteomyelitis: A retrospective study. Issue 2 (January 2019) - Zhan, Canyang
Abstract : 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.