Learning objectives
Neonatal osteomyelitis, although a rare complication, remains a diagnostic and therapeutic challenge. The purpose of our study is to demonstrate the vital role of MRI in diagnosis of osteomyelitis in neonates and infants, in correlation to location and extension.
Background
Neonatal osteomyelitis is defined as a bacterial infection of bones and differs from what is seen in older children and adolescents. The incidence of osteomyelitis ranged from approximately 1 in 5000 to 7700 children and boys are affected nearly twice as often as girls. Douglas, in British Medical Journal 1898, reported the first case of osteomyelitis in infants. Associated risk factors include prematurity, low birthweight, preceding infection, bacteremia, exchange transfusion and the presence of an intravenous catheter.
Due to the bone anatomy and blood supply...
Findings and procedure details
Our study involved ten neonates - infants (seven boys and three girls, age range 15d-1y) with osteomyelitis and septic arthritis who had been admitted to our hospital during the last ten years.
The most frequent osteomyelitis site was:
·Femur (4), Fig. 3 , Fig. 4 , Fig. 5
·humerus (2), Fig. 6 , Fig. 7
·talus (2), Fig. 8
·sacrum and iliac (1), Fig. 9 , Fig. 10
·fibula (1)
One patient had septic arthritis in the knee in combination with osteomyelitis Fig. 11 ....
Conclusion
It is important to recognize osteomyelitis in neonates – infants and begin treatment quickly to prevent long-term and devastating sequelae.
Delays in treatment can lead to concurrent septic arthritis, subperiosteal abscess, pyomyositis, deep vein thrombosis, growth arrest, septicemia, multiorgan failure, and death.
MRI is the modality of choice for accurate and early diagnosis of osteomyelitis.
Personal information and conflict of interest
A. Anastasiou; Thessaloniki/GR - nothing to disclose G. Sapouridis; Thessaloniki/GR - nothing to disclose A. G. Baltatzidis; Thessaloniki/GR - nothing to disclose N. Zarbali; Thessaloniki/GR - nothing to disclose A. Markou; Thessaloniki/GR - nothing to disclose T. Nimas; Thessaloniki/GR - nothing to disclose A. Vildiridis; Thessaloniki/GR - nothing to disclose
References
Somford MP, Huibers MHW, Schuppen J, Struijs PAA and van Lee R, “Multifocal Osteomyelitis in a Neonate, an Overview of Diagnosis and Treatment”, J Orthop Res Physiother 2015, 1: 015.
A Pendleton and M. S. Kocher, “Methicillin-resistant staphylococcus aureus bone and joint infections in children,” Journal of the American Academy of Orthopaedic Surgeons, vol. 23, no. 1, pp. 29–37, 2015.
D. M. McPherson, “Osteomyelitis in the neonate,” Neonatal Network, vol. 21, no. 1, pp. 9–22, 2002.
A.C. Offiah, “Acute osteomyelitis, septic arthritis and discitis: Differences...