Osteoarthritis in the neonate: risk factors and outcome

OBJECTIVES: The aim of this study was to identify the clinical, radiological, and bacteriological features, risk factors, and outcome of neonates with bone and joint infections. STUDY DESIGN: Observational, retrospective, and analytical study of 77 patients less than 2 months of age, admitted to a tertiary neonatal intensive care unit (NICU) with the diagnosis of bone or joint infection, based on clinical, radiological, and microbiological criteria. RESULTS: Seventy-seven patients with 99 acute osteoarthritis foci in a 16 year period were included in the study. Risk factors for infection could be identified in 69 percent of the patients. The hip was the most frequent. Staphylococcus aureus was the main isolated microorganism. Twenty-nine infants (38 percent) had sequelae. Hip involvement, culture positive, and Staphylococcus aureus isolation were risk factors associated with sequelae. CONCLUSION: Osteoarticular infection is unusual in the neonate; however it is associated with an elevated incidence of sequelae. This mandates for a high degree of suspicion to diagnose this potentially disabling entity.

Radiografía directa de abdomen y correlación clínica en la enterocolitis necrotizante / Direct abdominal radiology and clinical correlation in the necrotizing enterocolitis

Propósito: Determinar la incidencia de enterocolitis necrotizante (ECN) en la población estudiada y categorizar los signos radiográficos, según la clasificación clínico- radiológica de Bell, en 6 grados de menor a mayor severidad (IA y B, IIA y B y IIIA y B), útil para definir conductas terapéuticas y pronóstico. Material y Método: Análisis retrospectivo de 550 historias clínicas de neonatos menores de 36 semanas asistidos en UCI Neonatal entre abril/septiembre de 2003. Se seleccionaron 45 recién nacidos (RN) que desarrollaron ECN y se evaluó: edad gestacional (EG), peso y presentación clínico- radiológica. Resultados: De los 550 RN, 45 (8%) presentaron ECN. La EG se halló con mayor frecuencia entre las 31 y 34 semanas (60%) y el 71% de los niños pesó al nacer entre 1000 y 2000 gramos. La presentación clínico-radiológica según la clasificación de Bell fue: IA: 9 casos (20%); IB: 10 casos (22%); IIA: 11 casos (24%); IIB: 7 casos (15%); IIIA: 3 casos (7%), IIIB: 5 casos (11%). Conclusión: La incidencia de ECN en la población estudiada fue del 8%, coincidente con la bibliografía. Se confirma el valor de la Rx directa de abdomen, ya que su rol no solo está vinculado al diagnóstico de la enfermedad sino que aporta elementos de valor para el pronóstico, control evolutivo y detección de complicaciones.

Purpose: Determine the incidence of necrotizing enterocolitis (NEC) on the studied population and categorized the radiological signs based on the Bell clinical - radiological classification, in 6 grades from lower to higher severity (IA and B, IIA and B and IIIA and B), necessary to define prognosis and therapeutical behaviors. Materials and Method: Retrospective analysis of 550 clinical cases of neonates younger than 36 weeks assisted in UCI Neonatal between April and September 2003. Fourty five new born that developed NEC were selected, and the gestational age (GA), weight and clinical radiological presentation were evaluated. Results: From the 550 NB, 45 (8%) showed NEC. The GA that more frequently appeared was in between 31 and 34 weeks (60%) and 71% of the new born's weight was in between 1000 and 2000 grams. The clinical and radiological presentation by the Bell classification was: IA: 9 cases (20%); IB: 10 cases (22%); IIA: 11 cases (24%); IIB: 7 cases (15%); IIIA: 3 cases (7%); IIIB: 5 cases (11%). Conclusion: the incidence of NEC in the studied population was 8%, which agrees with the bibliography. It is confirmed the value of direct abdominal radiography, its role is not only linked to the diagnostic of the diseases, but it also gives valuable elements for the prognosis, evolutionary control and detection of complications.