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 Original Articles |
| Acute Septic Arthritis and Osteomyelitis in Neonatal Period |
| Weon Young Lee, Gwang Hoon Lee, Gil Hyun Kim, Hak Soo Lee, Do Hyun Moon* |
| Department of Pediatrics, Chung Ang Gil Hospital, Incheon, Korea |
Vol.28 Num.4 (p359~366)
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Background : Acute septic arthritis and osteomyelitis in neonatal period are difficult to diagnose and it may leave permannant sequelae. This study was performed to evaluate the clinical course, diagnosis, treatment and sequelae.
Methods : Thirty four neonates diagnosed as acute septic arthritis and osteomyelitis who were admitted to neonatal intensive care unit, in the department of pediatrics, Chung Ang Gil Hospital, were investigated for retrospective study.
Results : Acute septic arthritis involved the hip joint most frequently(16 cases, 19 joints), followed by knee joint (10 cases, 11 joints), and shoulder joint (8 cases, 8 joints). Acute osteomyelitis occurred concomittently in 6 cases (17.6%). Sex ratio was 1.6:1 with male predomenance. Twenty cases (58.8%) of the neonates had some antecedant illness or certain procedures prior to the diagnosis. Limitation of movement of limb and arthralgia were found in all cases, and swelling of the joints in 23 cases. MRI(magnetic resonance imaging) was the most sensitive diagnostic method, and radiographic changes of lateral subluxation and metaphyseal rarefaction were noted in 28 of 42 joints. Staphylococcus aureus was cultured in 10 cases (29.4%) and 7 cases (70.0%) of those cases were sensitive to third-generation cephalosporins and 10 cases (100%) were sensitive to vancomycin. Klebsiella pneumoniae was cultured in 8 cases (23.5%) and Enterobacter cloacae in 5 cases (14.7%), Proteus mirabilis in 2 cases (5.9%). Thirteen cases (86.7%) of gram-negative bacili were sensitive to amikacin. No organisms were cultured in 8 cases (23.5%). Average interval between the onset of the clinical symptoms and the initial time of operation was 5.14 days. The hip joint had yielded most frequent complications (14 cases) followed by shoulder and knee joint.
Conclusion : The prognosis of acute septic arthritis and osteomyelitis is well correlated to the interval between the onset of the clinical symptoms and the initial time of operation, the type of joints, and the status of osteomyelitis. Early diagnosis and treatments is essential for the prevention of permanant physical handicaps.
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Keywords : Acute septic arthritis, Osteomyelitis, Neonate |
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