|LETTERS TO EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 149
Septic as an arthritis cause of early neonatal sepsis in sick term newborn: Is it really uncommon?
Pankaj Kumar Mohanty1, Gurudip Das2, Shasanka Shekhar Panda3, Mrinal S Pillai1
1 Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka, India
2 Department of Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
3 Department of Pediatric Surgery, AIIMS, Bhubaneswar, India
|Date of Web Publication||6-Apr-2015|
Dr. Pankaj Kumar Mohanty
Department of Neonatology, Manipal Hospital, Bengaluru - 560 017, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohanty PK, Das G, Panda SS, Pillai MS. Septic as an arthritis cause of early neonatal sepsis in sick term newborn: Is it really uncommon?. J Clin Neonatol 2015;4:149
|How to cite this URL:|
Mohanty PK, Das G, Panda SS, Pillai MS. Septic as an arthritis cause of early neonatal sepsis in sick term newborn: Is it really uncommon?. J Clin Neonatol [serial online] 2015 [cited 2020 Jul 15];4:149. Available from: http://www.jcnonweb.com/text.asp?2015/4/2/149/154137
Sick preterm and term neonates can suffer from early and late neonatal sepsis. Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the 1 st month of life.  Neonatal osteomyelitis, as a cause of sepsis, is a rare event and often challenging. We witnessed two cases in our, first baby was a term neonate, born to a G2 P1 L1 mother by cesarean section, with uneventful perinatal period, no risk of infection in the mother, delivered healthy. Neonate was on exclusive breast feeding after birth and on day 4, developed lethargy, poor feeding and jaundice. C-reactive protein was elevated. However, other investigations evaluating sepsis such was blood culture, urine routine examination, urine culture and cerebrospinal fluid study was negative. There was a limitation of movement in the right hip joint. X-ray of local area was inconclusive. Ultrasonography hip joint was suggestive of effusion in the joint. Thick purulent pus was aspirated from the effusion under ultrasound guidance. Synovial fluid cytology revealed 30,000 cells/cm 3 with polymorphonuclear predominance. Culture of effusion showed methicillin resistant Staphylococcus aureus, which was treated with 6 weeks of intravenous sensitive antibiotics. Second patient was an extramural term neonate born to a primigravida mother by vaginal delivery. On day 7, baby was found to have poor feeding, lethargy and therefore admitted in neonatal intensive care unit. After 48 h, patient was found to have reduced movement of left hip joint. Patient was similarly evaluated. Cytology of synovial fluid showed 45,000 cells/cm 3 with polymorphonuclear predominance, but the culture of the hip joint effusion was sterile. The baby was treated empirically with intravenous linezolid for 6 weeks because the most common cause is S. aureus. The culture yield depends on of multiple factors such as the concentration of an organism in the effusion, volume of effusion, fastidious nature of the organism and presence of antibacterial factors in the effusion. 
Septic arthritis is a very uncommon cause of neonatal sepsis. Neonates presenting with signs and symptoms of sepsis should be examined in detail for limitation of major joint movement. Affected hip joint assumes a posture of flexion, abduction and external rotation. Ultrasound is a useful modality to detect septic arthritis. Physicians must maintain a high index of suspicion irrespective of ultrasound findings and have a low threshold for joint aspiration. Coexistence of osteomyelitis has been observed in septic arthritis. However, it commonly presents at older age. Most common causative organism of septic arthritis is S. aureus. Early diagnosis by frequent examination of joints and prompt treatment are important in the management. Affected neonates usually survive with appropriate treatment. Permanent skeletal deformity can occur as sequelae. The most serious complication of the septic arthritis of the hip, especially in newborns, is the avascular necrosis of the femoral head, which can lead to partial or complete destruction of the capital femoral epiphysis, the growth plate or both. 
| References|| |
Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr 2008;75:261-6.
Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK health district 1982-1991. Ann Rheum Dis 1999;58:214-9.
Lee SW, Irwin GJ, Huntley JS. Neonatal hip septic arthritis: Ultrasound should not influence decision to aspirate. Scott Med J 2013;58:e18-21.