Bone and joint infection in the neonate.

Bone and joint infections during the neonatal period differ from those in the older child. Neonates are relatively immunocompromised and their growth plate is pierced by blood vessels. Special characteristics of skeletal infection in the neonate are: (1) multiple foci of infection; (2) simultaneous involvement of the bone and the adjacent joint; and (3) limited systemic and local inflammatory response. The more common causative organisms are group B Streptococcus, Staphylococcus aureus, and gram-negative bacteria. Clinical findings can be minimal or absent. The more common findings include local swelling and limited motion in a joint or a limb. Early soft tissue radiographic changes are found in most cases and should be looked for. Every suspected bone or joint should be aspirated. Hip joint aspiration is recommended in the presence of other skeletal infection, even without local signs. Intravenous antibiotic treatment is started according to Gram's stain results or the best "educated guess." Surgical debridement is indicated for every site of pus in the extremities. Joint destruction and bone deformity and shortening are a common outcome. The only way to minimize early and late complications is high index of suspicion, aggressive workup, and adequate early treatment.