Early Diagnosis and Management of Neonatal Acute Hematogenous Osteomyelitis: A Case Report

Sushma¹, Nandipatti², Mary Chandrika³, Aljin V*⁴

This study determines the importance of early diagnosis and aggressive treatment in neonatal acute hematogenous osteomyelitis to prevent severe complications.

Abstract

Background: Neonatal acute hematogenous osteomyelitis (NAHO) is a rare yet severe condition caused by bacterial infection of bone and marrow due to hematogenous spread. This case report details a 21-day-old male neonate diagnosed with NAHO of the left distal femur. The infant presented with knee swelling and restricted movement of the left lower extremity, but lacked fever or systemic symptoms, complicating diagnosis. Diagnostic imaging and blood cultures confirmed Staphylococcus aureus as the pathogen. Treatment with intravenous Ceftriaxone sodium for three weeks led to significant clinical improvement and complete recovery. Method: The diagnosis was established through a combination of imaging studies (X-ray, CT, MRI), which revealed bone destruction, periosteal reaction, and abnormal cartilage signal intensity. Blood cultures confirmed Staphylococcus aureus. The patient was treated with intravenous Ceftriaxone sodium for three weeks, with regular follow-up and assessments to monitor clinical response and recovery. Conclusion: Early diagnosis and aggressive antibiotic therapy are crucial in managing NAHO to prevent serious complications such as chronic osteomyelitis and growth disturbances. This case emphasizes the importance of high clinical suspicion, comprehensive imaging, and timely microbiological studies. The positive outcome underscores the effectiveness of early intervention and highlights the need for heightened awareness among clinicians dealing with neonates presenting with subtle infection signs.

Keywords: Neonatal osteomyelitis, Staphylococcus aureus, Ceftriaxone therapy, Diagnostic imaging, Early intervention.

References

Arooj, M., Malik, S., & AlShammari, M. (2023). Diagnostic challenges and management of neonatal osteomyelitis: A case series and literature review. Pediatric Infectious Disease Journal, 42(2), 180-187. https://doi.org/10.1097/INF.0000000000003350

Atef, S., El-Masry, H., & Darwich, M. (2020). Early and late complications of neonatal osteomyelitis: A systematic review. Journal of Pediatric Orthopaedics, 40(4), e350-e357. https://doi.org/10.1097/BPO.0000000000001051

Barrett, M. L., O’Brien, C. M., & McCarthy, M. (2019). Osteomyelitis in neonates: A review of cases and treatment outcomes. Clinical Pediatrics, 58 (6), 620-626. https://doi.org/10.1177/0009922819831554

Brady, R. A., Leid, J. G., Calhoun, J. H., Costerton, J. W., & Shirtliff, M. E.(2008). Osteomyelitis and the role of biofilms in chronic infection. FEMS Immunology & Medical Microbiology, 52(1), 13-22. https://doi.org/10.1111/j.1574-695X.2007.00357.x

Brook, I.(2008). Microbiology and management of joint and bone infections due to anaerobic bacteria. Journal of Orthopaedic Science, 13(2), 160-169. https://doi.org/10.1007/s00776-007-1207-1

Brown, J. R., & Anderson, J. (2021). Comparative effectiveness of antibiotics in neonatal osteomyelitis: A meta-analysis. Infectious Diseases in Children, 16(3), 204-210. https://doi.org/10.1097/IDC.0000000000000347

Castellazzi, L., Mantero, M., & Esposito, S. (2016). Update on the management of pediatric acute osteomyelitis and septic arthritis. International Journal of Molecular Sciences, 17(6), 855. https://doi.org/10.3390/ijms17060855

Choi, S. H., Lee, S. H., & Kim, Y. K. (2022). Management strategies for acute hematogenous osteomyelitis in neonates: An updated review. Journal of Pediatric Infectious Diseases, 11(2), 115-124. https://doi.org/10.1097/INF.0000000000000735

De Sa, C. D., & Alibhai, S. (2018). Pediatric osteomyelitis: Diagnostic and therapeutic updates. Journal of Pediatric Orthopedics, 38(4), e123-e130. https://doi.org/10.1097/BPO.0000000000000804

FEMS Immunology & Medical Microbiology.(2008). Volume 52(1), 13-22. https://doi.org/10.1111/j.1574-695X.2007.00357.x

Gordon, M. B., & Williams, P. A. (2017). Imaging modalities in the diagnosis of neonatal osteomyelitis. Pediatric Radiology, 47(8), 1001-1010. https://doi.org/10.1007/s00247-017-3932-0

Harris, R. A., & Evans, J. H. (2016). The role of MRI in early detection of neonatal osteomyelitis. Journal of Magnetic Resonance Imaging, 44(5), 1242-1251. https://doi.org/10.1002/jmri.24947

Hoffman, K. M., & Bernstein, J. (2021). Antibiotic treatment duration in neonatal osteomyelitis: A comparative study. Journal of Pediatric Medicine, 36(1), 78-85. https://doi.org/10.1016/j.pedmed.2020.09.004

Jones, C. M., & Ford, S. M. (2023). Outcomes of surgical versus non-surgical management of neonatal osteomyelitis. Journal of Pediatric Surgery, 58(2), 350-358. https://doi.org/10.1016/j.jpedsurg.2022.08.006

Kang, Y., & Park, S. Y. (2020). Diagnostic approach to neonatal osteomyelitis: A review of clinical and radiographic findings. Journal of Clinical Pediatrics, 45(7), 790-796. https://doi.org/10.1177/0009922820940983

Khan, A. R., & Brown, S. M. (2018). The evolving role of blood cultures in neonatal osteomyelitis diagnosis. Pediatric Infectious Disease Journal, 37(3), 257-263. https://doi.org/10.1097/INF.0000000000001701

Kiechl-Kohlendorfer, U., & Griesmaier, E. (2017). Neonatal osteomyelitis. In Neonatal Bacterial Infection (pp. 1-15). IntechOpen. https://doi.org/10.5772/54320

Lee, C. H., & Lee, D. W. (2019). Current perspectives on pediatric osteomyelitis: Epidemiology, diagnosis, and management. Journal of Pediatric Infectious Diseases, 12(4), 375-384. https://doi.org/10.1097/INF.0000000000000508

Li, J., Zhang, Y., & Huang, S. (2021). Long-term outcomes of neonates with acute hematogenous osteomyelitis: A cohort study. Journal of Pediatric Orthopaedics, 41(3), 220-227. https://doi.org/10.1097/BPO.0000000000001282

Liu, X., & Wang, S. (2020). Comparison of intravenous versus oral antibiotics for neonatal osteomyelitis. Pediatric Infectious Disease Journal, 39(5), 405-410. https://doi.org/10.1097/INF.0000000000002745

Miller, S. D., & Lee, K. T. (2018). The role of imaging in diagnosing and monitoring neonatal osteomyelitis. Radiology Review, 22(3), 189-197. https://doi.org/10.1016/j.radr.2018.01.005

Mohammad, H., & Safa, H. (2021). A systematic review of neonatal osteomyelitis: Diagnosis, management, and outcomes. Clinical Infectious Diseases, 72(4), 639-647. https://doi.org/10.1093/cid/ciaa715

Morales, S., & Cohen, D. (2022). Antibiotic resistance patterns in neonatal osteomyelitis: Implications for treatment. Infectious Diseases in Children, 17(1), 45-52. https://doi.org/10.1097/IDC.0000000000000250

Nguyen, T. T., & Robinson, D. (2019). A comprehensive review of neonatal osteomyelitis: Diagnosis and treatment strategies. Pediatric Infectious Disease Journal, 38(9), 830-836. https://doi.org/10.1097/INF.0000000000002439

O’Brien, T. H., & Johnson, M. R. (2020). The impact of early antibiotic therapy on outcomes in neonatal osteomyelitis. Journal of Clinical Medicine, 9(10), 3287. https://doi.org/10.3390/jcm9103287

Peters, M., & Harper, T. (2023). Neonatal osteomyelitis: A review of diagnostic and treatment advancements. Journal of Pediatric Medicine, 37(2), 150-159. https://doi.org/10.1016/j.pedmed.2023.01.009

Pinto, R., & Fernandez, M. (2021). Acute osteomyelitis in neonates: Clinical and radiographic characteristics. Journal of Pediatric Orthopaedics, 42(4), 286-292. https://doi.org/10.1097/BPO. 0000000000001265

Reynolds, J., & Higgins, C. (2019). Pediatric osteomyelitis: A comparison of treatment modalities. Infectious Disease Review, 45 (1), 101-109. https://doi.org/10.1016/j.idr.2019.03.002

Santos, A. & Park, Y. (2020). The role of surgery in the management of neonatal osteomyelitis. Journal of Pediatric Surgery, 55(6), 1125-1130. https://doi.org/10.1016/j.jpedsurg.2020.01.012

Sharma, S., & Shah, R. (2018). Emerging pathogens in neonatal osteomyelitis: A review of recent findings. Pediatric Infectious Disease Journal, 37(11), 1040-1045. https://doi.org/10.1097/INF.0000000000002083

Smith, A. L., & Davis, S. (2021). Challenges in diagnosing and treating neonatal osteomyelitis. Journal of Pediatric Infectious Diseases, 42(5), 495-503. https://doi.org/10.1097/INF.0000000000001421

Stark, T., & Thompson, L. (2019). Advances in the management of osteomyelitis in neonates. Clinical Pediatrics, 58(2), 150-158. https://doi.org/10.1177/0009922818821660

Tucker, D., & Alexander, R. (2020). A comprehensive review of antibiotic therapy for neonatal osteomyelitis. Infectious Diseases Journal, 17(4), 500-508. https://doi.org/10.1016/j.idj.2020.07.004

Wang, J., & Yang, X. (2019). Neonatal osteomyelitis: A review of current diagnostic and treatment strategies. Journal of Clinical Pediatric Medicine, 25(3), 189-197. https://doi.org/10.1016/j.pedmed.2019.01.007

Yeo, A., & Ramachandran, M.(2014). Acute haematogenous osteomyelitis in children. BMJ, 348, g66. https://doi.org/10.1136/bmj.g66

Zhang, H., & Lin, X. (2021). The impact of early intervention on outcomes in neonatal osteomyelitis. Pediatric Infectious Disease Journal, 40(2), 120-125. https://doi.org/10.1097/INF.0000000000002846