Septic arthritis in the newborn--a 17 years' clinical experience

Septic arthritis is an uncommon, yet serious disorder in the newborn. Most patients survive with permanent handicaps. We encountered 11 cases of neonatal septic arthritis in the Hospital over the past 17 years (1971-87), an incidence of 0.12 per 1000 livebirths or 0.67 per 1000 admissions to the neonatal nursery. The clinical experience is presented. The diagnosis of septic arthritis in the newborn is more difficult than in the older children. Joint swelling (10/11), tenderness (9/11) and limitations of joint movement (8/11) were the common presenting clinical signs. Constitutional symptoms (fever, leucocytosis, gastrointestinal disturbances) were unremarkable. More than half of the babies (6/11) were prematurely born. The knees and the hips were frequently infected, many had multiple joint involvement (6/11). Septic arthritis commonly manifested between 20-40 days of life. The causative agents viz. Staphylococcus aureus (4/11), Candida (2/11), Citrobacter (1/11) and Methicillin Resistant Staphylococcus aureus MRSA (4/11) showed that septic arthritis was a nosocomial infection. Many babies (9/11) had insertion of intravascular catheter for 1-3 weeks and 9/11 babies had concomitant positive blood culture, 2/11 coexisting osteomyelitis and 1, meningitis. Though there was no death, majority of the babies had joint destruction and severe handicap. Early diagnosis including frequent examinations of joints, prompt treatment and control of nosocomial infection are important in management.