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Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study
Yun Gao1, Ruikang Liu2, Saroj Rai3
1Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China.
Insights
Surgical treatment for neonatal humeral epiphyseal osteomyelitis significantly improves recovery rates and reduces hospital stays compared to conservative methods. Early surgical intervention is recommended for better outcomes in infants with this bone infection.
Area of Science:
- Pediatrics
- Orthopedic Surgery
- Infectious Diseases
Background:
- Neonatal humeral epiphyseal osteomyelitis is a serious bone infection in infants.
- Treatment options include conservative management and surgical intervention.
- Optimal treatment strategies require further investigation.
Purpose of the Study:
- To retrospectively review and compare treatment outcomes for neonatal humeral epiphyseal osteomyelitis.
- To evaluate the efficacy of conservative versus surgical management.
- To assess the impact of early versus delayed surgical intervention.
Main Methods:
- Retrospective cohort study design.
- Inclusion of infants diagnosed with neonatal humeral epiphyseal osteomyelitis.
- Categorization of patients into conservative, early surgical, and delayed surgical groups.
Main Results:
- Surgical group showed significantly shorter hospital stays and antibiotic courses (p < 0.001).
- Full recovery rates were higher in the surgical group (83.3%) versus conservative (14.3%) (p < 0.001).
- Early surgery group had a trend towards higher positive culture rates and full recovery than the delayed surgery group.
Conclusions:
- Surgical treatment is superior to conservative management for neonatal humeral epiphyseal osteomyelitis.
- Early surgical intervention appears to yield better outcomes than delayed surgery.
- Antibiotic therapy should be guided by local bacterial epidemiology, with Gram-positive bacteria being common.
Abstract:
Objective: To review the treatment experience of neonatal humeral epiphyseal osteomyelitis retrospectively. Study design: Retrospective cohort study of infants with neonatal humeral epiphyseal osteomyelitis. Patients were divided into conservative group and surgical group, and the surgical group was subdivided into early and delayed surgical group. Results: In total, there were 7 patients in the conservative group and 24 in the surgical group. The length of hospital stay and intravenous course of antibiotic therapy were both significantly shorter in the surgical group (p < 0.001). The full recovery rate was also higher in the surgical group (83.3%) than the conservative group (14.3%) (p < 0.001). Early surgery group (n = 14) had an insignificantly higher positive rate of pus/aspirate culture and full recovery rate than delayed surgery group (n = 10). Conclusion: Surgical treatment for neonatal humeral epiphyseal osteomyelitis demonstrated significantly higher rates of positive culture for the pathogen, a shorter course of intravenous oral antibiotics, and lower incidence of growth abnormality than conservative treatment. In our institution, most of culture outcome Gram-positive bacteria, and early surgical treatment was recommended with better outcome than delayed surgical group. Empirical antibiotics should be tailored to the epidemiological characteristics of local virulent bacteria.
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