Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Neonatal osteomyelitis: an Italian multicentre report of 22 cases and comparison with the inherent literature

Journal of Perinatology volume 41, pages 1293–1303 (2021)Cite this article

Subjects

Abstract

Objective

The primary objective of this study is to report and compare our data with the most relevant literature of the past decade about neonatal osteomyelitis.

Study design

We retrospectively review the data of 22 subjects aged 35 days or less who were admitted to three different sites in Italy with a radiological diagnosis of osteomyelitis. The inherent literature was searched and reviewed: five studies were considered for comparison with our data.

Results

All the neonates, except three (two pre-term and one post-term), were born at term. The male to female ratio was 1.75 (14 males and 8 females). The mean age at presentation was 19.5 days. The most common presenting signs of the infection were local swelling and reduced mobility of the affected segment. The most common sites of infection were the femur, humerus, and tibia. The mean duration of intravenous antibiotic therapy was 29.5 days. In most neonates the diagnosis was prompt and the antibiotic treatment immediate. A low rate of sequelae was reported. All infants survived through follow up. The data from the inherent literature showed a wide variability, probably owing to the setting and the historical period of the different studies.

Conclusion

Neonatal osteomyelitis is an alarming yet poorly understood disease. Nonetheless, our report suggests that a quick diagnosis and treatment can be easily achieved, with good outcome on the remarkably plastic structure of neonatal bones.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Parsch K, Nade S (2010). Infections of bones and joints. In: Benson M, Fixsen J, Macnicol M, Parsch K (ed). Children’s orthopaedics and fractures. Third ed. London: Springer-Verlag, 2010, pp 135–259.

  2. Vorhies JS, Lindsay EA, Tareen NG, Kellum RJ, Jo CH, Copley LA. Severity adjusted risk of long-term adverse sequelae among children with osteomyelitis. Pediatr Infect Dis J. 2019;38:26–31.

    Article  Google Scholar 

  3. Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study. J Med Assoc Thai. 2011;94:S209–S216.

    PubMed  Google Scholar 

  4. Christiansen P, Frederiksen B, Glazowski J, Scavenius M, Knudsen FU. Epidemiologic, bacteriologic, and long-term follow-up data of children with acute hematogenous osteomyelitis and septic arthritis: a ten-year review. J Pediatr Orthop B. 1999;8:302–5.

    CAS  PubMed  Google Scholar 

  5. Mitha A, Boutry N, Nectoux E, Petyt C, Lagrée M, Happiette L. Community-acquired bone and joint infections in children: a 1-year prospective epidemiological study. Arch Dis Child. 2015;100:126–9.

    Article  Google Scholar 

  6. Riise ØR, Kirkhus E, Handeland KS, Berit Flatø B, Reiseter T, Cvancarova M, et al. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr. 2008;8:45.

    Article  Google Scholar 

  7. Ogden JA. Pediatric osteomyelitis and septic arthritis: the pathology of neonatal disease. Yale J Biol Med. 1979;52:423–448.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Overturf GD. Bacterial infections of the bones and joints. In: Remington JS et al. (eds). Infectious diseases of the fetus and newborn infant. 7th ed. Philadelphia, PA: Elsevier Saunders, 2011, pp 322.

  9. Shalabi M, Adel M, Yoon E, Aziz K, Lee S, Shah PS. Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates. Pediatrics. 2015;136:1073–1079.

    Article  Google Scholar 

  10. Gordon A, Greenhalgh M, McGuire W. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev. 2017;10:CD012142.

    PubMed  Google Scholar 

  11. McPherson DM. Osteomyelitis in the neonate. Neonatal Netw. 2002;21:9–22.

    Article  Google Scholar 

  12. Mok PM, Reilly BJ, Ash JM. Osteomyelitis in the neonate. Clinical aspects and the role of radiography and scintigraphy in diagnosis and management. Radiology. 1982;145:677–682.

    Article  CAS  Google Scholar 

  13. Bergdahl S, Ekengren K, Eriksson M. Neonatal hematogenous osteomyelitis: risk factors for long-term sequelae. J Pediatr Orthop 1985;5:564–568.

    Article  CAS  Google Scholar 

  14. Weissberg ED, Smith AL, Smith DH. Clinical features of neonatal osteomyelitis. Pediatrics. 1974;53:505–510.

    CAS  PubMed  Google Scholar 

  15. Knudsen CJ, Hoffman EB. Neonatal osteomyelitis. J Bone Jt Surg Br. 1990;72:846–851.

    Article  CAS  Google Scholar 

  16. Zhan C, Zhou B, Du J, Chen L. Clinical analysis of 17 cases of neonatal osteomyelitis: a retrospective study. Medicines. 2019;98:e14129.

    Google Scholar 

  17. Hu Y, Chen QX. Clinical analysis of 7 cases of neonatal hematogenous osteomyelitis. Chin J Contemp Pediatr. 2013;15:785–7.

    Google Scholar 

  18. Brill PW, Winchester P, Krauss AN, Symchych P. Osteomyelitis in a neonatal intensive care unit. Radiology. 1979;131:83–87.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study did not receive any fund. The article is intellectual property of the authors that contributed to its designing and writing.

Author information

Authors and Affiliations

  1. University of Rome Tor Vergata, Residency School of Paediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Marco Roversi & Daniele Deriu

  2. Paediatric Infectious Disease Unit, Anna Meyer Children’s University Hospital, Florence, Italy

    Elena Chiappini & Luisa Galli

  3. Department of Orthopaedics and Traumatology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Renato Maria Toniolo

  4. Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Marco Cirillo

  5. Department of Maternal and Child Health and Urologic Science, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy

    Fabio Natale

  6. Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Annalisa Grandin, Laura Lancella, Alberto Villani & Andrzej Krzysztofiak

Authors
  1. Marco Roversi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Chiappini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renato Maria Toniolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Cirillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Deriu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Annalisa Grandin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laura Lancella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luisa Galli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alberto Villani
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andrzej Krzysztofiak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MR conceptualized and designed the article, collected data, drafted and wrote the manuscript and tables, reviewed, and revised the final manuscript. EC provided and supervised data, reviewed and accepted the final manuscript. RMT provided surgical expertise for the management of neonatal osteomyelitis, reviewed, and accepted the final manuscript. MC provided imaging expertise for the diagnosis of neonatal osteomyelitis, reviewed and accepted the final manuscript. FN provided and supervised data, reviewed, and accepted the final manuscript. DD collected data, reviewed, and accepted the final manuscript. AG reviewed and accepted the final manuscript. LL reviewed and accepted the final manuscript. LG reviewed the manuscript for important intellectual content, reviewed and accepted the final manuscript. AV reviewed the manuscript for important intellectual content, reviewed, and accepted the final manuscript. AK provided, coordinated, and supervised data, reviewed, and accepted the final manuscript.

Corresponding author

Correspondence to Marco Roversi.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roversi, M., Chiappini, E., Toniolo, R.M. et al. Neonatal osteomyelitis: an Italian multicentre report of 22 cases and comparison with the inherent literature. J Perinatol 41, 1293–1303 (2021). https://doi.org/10.1038/s41372-021-00956-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-00956-4

This article is cited by

Search

Advanced search

Quick links