Prognostic outcomes of neonatal septic arthritis: a systematic review and meta-analysis

The unique vulnerability of the neonatal joint to septic arthritis poses a substantial risk for lifelong musculoskeletal disability. Precise estimates of long-term functional outcomes are crucial for prognostication and clinical decision-making, yet robust pooled data remain scarce. This systematic review and meta-analysis was therefore conducted to determine the aggregate rate of favorable prognosis in neonates following septic arthritis.

We queried four major databases (PubMed, Embase, Cochrane Library, and Web of Science) from inception until September 2025 to identify studies reporting Prognostic outcomes of neonatal septic arthritis. The primary outcome was the pooled rate of favorable prognosis, defined as normal/near-normal joint function, synthesized under a random-effects model. Heterogeneity was quantified (I² statistic), and we explored its sources via pre-specified subgroup analyses and sensitivity analyses.

Thirteen studies (258 patients) were included. The pooled rate of favorable prognosis was 69.7% (95% CI: 60.5-77.7). Significant heterogeneity (I² = 40.9%) was observed. Subgroup analyses identified longer follow-up (> 2 years), non-hip joint involvement, and prompt intervention (≤ 7 days) as significant positive predictors of outcome.

Approximately one-third of infants with neonatal septic arthritis experience adverse sequelae. Prognosis is significantly influenced by follow-up duration, anatomic site of involvement (particularly the hip), and the timeliness of intervention. These findings highlight the paramount importance of early diagnosis and urgent treatment, providing crucial evidence for family counseling and structuring long-term follow-up protocols.