Neonatal septic arthritis: Clinical profile and predictors of outcome

Abstract

Background: Neonatal septic arthritis deserves a special attention due to its subtle signs and symptoms and catastrophic consequences. There is paucity of literature regarding the clinical profile and predictors of outcome in neonatal septic arthritis. Objectives: The objective was to study the clinical profile of neonates admitted with septic arthritis, their clinical and radiological outcomes on follow-up, and factors that predict outcomes. Methodology: Neonates with septic arthritis as assessed by retrospective case sheet review were included. Prospective data collection of clinical and radiological outcomes was done during follow-upvisits. Children with good outcomes (controls) were compared to those with poor outcomes (cases) subsequently to identify the predictors of outcomes using a nested case–control design. Results: Data of 70 neonates admitted with septic arthritis were collected. Single joint involvement was common (75.8%), and hip joint was the most common joint involved. Gram-negative organisms were predominant (72%), and Klebsiella was the most common organism isolated from joint aspirate (36%), followed by Escherichia coli and Staphylococcus aureus. Of 52 babies who turned for follow-up, half had poor outcomes. In univariate analysis,multiple joint involvement (odds ratio [OR] 4.79, [confidence interval (CI): 1.14-20.21]), pre-intervention period ?7 days (OR 92, [CI: 14.06-601.9]), culture positive joint aspirate (OR 3.70, [CI: 1.55-11.86]), and restricted range of joint movements at discharge (OR 83.3, [CI: 9.2-749.9]) were significantly associated with poor outcomes. Pre-intervention period ?7 days (adjusted OR 107.99, [CI: 5.16-2258.8]) and restricted joint mobility at discharge (adjusted OR 139.53, [CI: 9.03-2154.04]) were the independent predictors of poor overall outcome by logistic regression analysis. Conclusions: Long pre-intervention period and restricted joint mobility at discharge were independent predictors of poor outcome in neonatal septic arthritis. We emphasize the importance ofearly diagnosis, prompt referral to tertiary centers, timely surgical intervention, appropriate measures to ensure good joint mobility, and regular follow-up in these neonates to achieve best outcomes.

The Significance of Septic Arthritis in Neonatal Intensive Care Unit

“…Among sepsis group without arthritis there was15 cases came with false symptoms of arthritis as inability to move limbs, pain, and tenderness but there was no radiological or ultrasonographic feature of arthritis even with further re-evaluation. The prognosis was good [3].…”

“…Good Xray films were important diagnostic test for septic arthritis, as well as joint sonogram. Anticipation, early prediction means early medication and avoidance of joint destruction [1,3].…”

A Neonatal Hip Septic Arthritis Caused by Klebsiella pneumonia at Hawassa University Comprehensive Specialized Hospital Neonatal Unit, Hawassa, Sidama, Ethiopia

“…3,4,22,23 A study done by Usha et al showed as long as 7 days of pre-intervention period and restricted joint mobility at discharge were shown to be the independent determinants of poor overall outcome in neonatal septic arthritis. 6 The radiological prognosis was found to be poorer among neonates who had comorbidities, a longer duration of symptoms, and pus drainage. Of all these, the duration of symptoms is the most important predictor of a poor radiological prognosis.…”

“…20 A study done by Devi et al reported that Klebsiella pneumonia was the most common Gram-negative organism, which constitutes about 36% of the cases, followed by Escherichia coli and Staphylococcus aureus. 6,8 Hip joint arthritis has a tendency to present as abdominal mass via extension through obturator internus, posing a diagnosis challenge. 18 So it is wise to think of hip joint origin for abdominal mass, and it highlights the use of abdominopelvic sonography in such cases.…”

“…A study done by Devi et al reported that Klebsiella pneumonia was the most common Gram-negative organism, which constitutes about 36% of the cases, followed by Escherichia coli and Staphylococcus aureus. 6,7 Klebsiella pneumonia must enter the bloodstream or the respiratory tract to cause a bloodstream infection or pneumonia. It is easily transmitted through person-toperson contact, especially in settings with inadequate infection prevention and control.…”