Volume 11 Supplement 4

Sepsis 2007

Open Access

System approach to the diagnosis and treatment of septic arthritis in newborns

  • Gennadiy Khanes1,
  • Svitlana Bidnenko2,
  • Volodymyr Grygorovskyy3,
  • Iryna Maksakova1 and
  • Valeriy Romashko4
Critical Care200711(Suppl 4):P8

https://doi.org/10.1186/cc5987

Published: 26 September 2007

Background

Bone and joint sepsis occurs in 20% of newborns having perinatal sepsis. The feature of septic arthritis against the background of age-specific functional immunodeficiency gives us a reason to consider this decease as the manifestation of immunodeficiency. Septic arthritis in newborns is lethal in 10% of cases and gives orthopedic complications in 20% of cases. The starting moments of septic arthritis development are: mother's intrauterine infection and nosocomial infecting in maternity hospitals and intensive care departments, and purulent omphalitis.

Materials and methods

We present the experience of diagnostics and treatment of 180 newborns aged 3 days and older having septic affection of the hip, knee, shoulder and other joints. The crucial role in diagnostics of septic arthritis is played by: cytology of smear, ultrasonic examination of a joint, X-ray examination of a joint, bacteriological, serological, PCR and PCT-Q. The bacteriological monitoring in 30% of newborns among the pathogens showed CoMRSA, often mixed with fungi and Pseudomonas aerogenes or Klebsiella pneumonia, and in 10% there was PCR of Toxoplasma gondi, Chlamidia trachomatis or cytomegalovirus. Immunological monitoring allowed one to determine the patients who needed substitute therapy by immunoglobulin and a number of immunomodulators. The degree of infection process severity and the adequacy of antibacterial therapy are determined by serologic investigations, PCR and PCT-Q. The treating complex included joint lavage, antibiotics, anticytokine, antifungal agents, probiotics, and magnetic-laser therapy.

Results

The lethality was reduced to zero, transition into the chronic form was up to 2.5%, and orthopedic complications were presented in 10% of cases.

Conclusion

The after-history of treatment was researched and showed that when the diagnosis was made in less than 3 days, complications occurred in 3.3% of cases, and after 6–7 days the complications occurred in 22.4% of patients.

Authors’ Affiliations

(1)
Neonatal Surgery Department, Ukrainian Specialized Pediatric Hospital OkhMatDyt
(2)
Bacteriologic Laboratory of Scientific Research Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine
(3)
Morphologic Laboratory of Scientific Research Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine
(4)
Immunologic Laboratory, Ukraine Specialized Pediatric Hospital OkhMatDyt

Copyright

© BioMed Central Ltd 2007

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