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Long-term effects of neonatal bone and joint infection on adjacent growth plates
Insights
Neonatal bone and joint infections can cause growth plate damage, leading to long-term growth interference. Close monitoring of children with these infections until skeletal maturity is crucial for detecting late complications.
Area of Science:
- Pediatric Orthopedics
- Neonatal Infectious Diseases
- Skeletal Growth and Development
Background:
- Neonatal infections can affect bone and joint structures.
- Physeal (growth plate) damage from infection may not be immediately apparent.
- Delayed diagnosis of growth disturbances can impact long-term outcomes.
Purpose of the Study:
- To review cases of physeal damage resulting from neonatal infections (excluding hip infections).
- To identify the incidence and patterns of growth interference following neonatal bone and joint infections.
- To emphasize the importance of long-term follow-up for affected children.
Main Methods:
- Retrospective review of pediatric patients with physeal damage from neonatal infections at Winnipeg Children's Hospital.
- Analysis of infection sites, affected growth plates, and long-term growth outcomes.
- Correlation of initial infection treatment with the development of growth abnormalities.
Main Results:
- Six patients experienced residual growth interference due to adjacent bone or joint infections.
- Commonly affected growth plates included distal femur, proximal humerus, and proximal femur.
- Growth abnormalities became evident years after initial infection treatment, around a mean age of 9 years.
Conclusions:
- Neonatal bone and joint infections can lead to significant, delayed-onset physeal damage and growth disturbances.
- Long-term surveillance of children with neonatal bone and joint infections is essential.
- Monitoring the physis for late tethering until skeletal maturity is recommended to manage potential growth abnormalities.
Abstract:
Review of children with physeal damage from neonatal infection other than the hip at Winnipeg Children's Hospital showed that six patients had residual growth interference from adjacent infection in the bone or joint. Several of the infections involved multiple joints, with growth plate arrest occurring in the distal femoral growth plate in four, in the proximal humerus in four, in the proximal femur in two, in the distal radius in one, and in the distal humerus in one. Although the initial infection was frequently believed to be successfully treated in the neonate, the clinical effect of these infections on the growth plate was not fully appreciated in five of the infants until the children reached a mean age of 9 years. Because growth abnormalities in physeal bars may not be clinically evident for several years after the initial infection has been treated, we recommend that children with bone and joint infections occurring in the first month of life be followed to skeletal maturity, observing the adjacent physis for late tethering.