Acute osteomyelitis and septic arthritis in the neonate, risk factors and outcome

Twenty-two neonates with acute osteomyelitis (AO) or septic arthritis (SA) were included in a study based on a review of medical reports and a long-term clinical and radiological follow up. Clinical symptoms, bacteriology, risk factors, and outcome are discussed. The diagnoses were difficult, the clinical symptoms vague, fever rare and white cell count normal. Detection by plain radiological films was more efficient than by radionuclide bone scan. Staphylococcus aureus was the predominant causative organism and a shift towards group B Streptococcus in recent years was not identified. Risk factors for AO and SA were prematurity (13/22), respiratory distress syndrome (15/22) and perhaps most important: umbilical artery catheterisation (15/22). Severe sequelae were found in only 1 patient, while 3 patients had slight asymptomatic changes. The relatively favourable long-term outcome is unexplained, but may be related to early and appropriate, long lasting antibiotic treatment.