Clinical Features of Septic Arthritis in Neonates

Kwak, Min Jung; Park, Su Eun

Abstract

PURPOSE
Septic arthritis is uncommon in neonates, and the diagnosis of septic arthritis in newborns is difficult because of non-specific laboratory findings and paucity of signs and symptoms. When appropriate treatment is delayed, permanant sequelae are inevitable. We report a retrospective study of 22 neonates who were diagnosed with septic arthritis.
METHODS
We reviewed 22 patients, who were diagnosed with septic arthritis in the nursery room of Pusan National University Hospital, between July 1, 1995 and December 31, 2003. We investigated demographic features, predisposing factors, symptoms and signs, involving sites, diagnostic methods, laboratory findings, causative organisms, treatments and outcomes in these neonates.
RESULTS
The mean age was 16.6 days(range 7-40 days). The male to female ratio was 1.44 : 1 with male predominance. Five of 22 neonates were prematurity. Eleven neonates were diagnosed with septic arthritis in hospitalization. Septic arthritis was multifocal in 22.7% and involved the hip joint most frequently(12 cases, 14 joints). Of diagnostic imaging studies, MRI was most sensitive, with four positivity in five cases. An etiologic organism was isolated from 11(50%) : Staphylococcus aure us, 7; GBS, 2; coagulase (-) staphylococcus, 1; Klebsiella pneumoniae 1. Of 13 surgical specimens from joint fluid, two were positive. Four neonates had sequelae over 1 year follow-up, three were in knee joints and one in the hip joint.
CONCLUSION
Four of 22 neonates who suffered from septic arthritis had sequelae, two were premature and three were diagnosed in hospitalization. To decrease hospital-acquired infections would decrease the incidence of septic arthritis and the frequency of permanant sequelae in neonates.