6227 Multifocal osteomyelitis and staphylococcus septicemia in a preterm newborn – a complex medical journey

Objectives This abstract aims to present although exceptionally rare, Neonatal osteomyelitis has been linked to destructive complications and delay in treatment can lead to longer term complications.¹ ³ Our study highlights a preterm newborn with Staphylococcus septicemia and multifocal osteomyelitis, the colossal importance of timely diagnosis, goal directed antibiotics, collaborative efforts from multidisciplinary team can prevent devastating disturbances in skeletal growth.¹ ² ⁴ Methods Retrospective review of preterm neonate admitted to our Local Neonatal Unit for ongoing management. Baby had late onset of sepsis and Staphylococcus septicemia at the end of the first week and developed a rarer complication of this (Neonatal osteomyelitis).⁸ ¹⁰ We review the literature and discuss current approaches to diagnosis and management.¹ ² ⁵ ⁶ ¹¹ Results Baby A was born prematurely at 31+3 weeks via normal vaginal delivery, medical journey involved oxygen therapy, CPAP, phototherapy for neonatal jaundice, septic deterioration, staphylococcus aureus septicemia and PICC line. Around 3 weeks of life baby had swelling of right leg and radiological evaluation confirmed evidence of osteomyelitis involving right tibia, left humerus and left femur. Treatment involved appropriate antimicrobial (flucloxacillin) for 6 weeks as advised from Microbiology and Immunology.⁵ ¹² For outcomes baby recovered completely and discharged at 55 days of age. There were no profound complications and no recurrence, baby had first immunization and the post-treatment condition was stable with plans for follow-up appointments. Conclusion This case highlights the necessity of early diagnosis and immediate collaborative intervention in preterm neonates facing complex medical challenges. Although neonatal osteomyelitis is infrequent,¹ ² it underscores the significance of rapid diagnosis and adherence to evidence-based clinical guidelines.⁶ ⁷ ¹¹ Baby's successful journey demonstrates the positive outcomes achievable through multidisciplinary teamwork.¹–³ This approach leads to shorter hospital stays, reduces re-admissions rates and offers hope to the medical community and parents navigating the intricacies of neonatal care.⁹ ¹⁰ ¹¹ References Castellezzi L, Mantero M. Update on the management of pediatric acute osteomyelitis and septic arthritis. Int J.Mol.Sci 2016;17(6):855. Dartnell J, Ramachandran M. Haematogenous acute and subacute pediatric osteomyelitis: a systemic review of literature. J.Bone Joint Surg.Br 2012;94(5):584–595. Mitsiakos G, Gialamprinou D. Osteomyelitis and thrombosis in a newborn with group a streptococcal infection. Prague medical report 2023;124(3):293–300. Berberian G, firpo V, Soto A. Osteoarthritis in the neonate: risk factors and outcome. Braz J Infect Dis 2010;14(4):413–418. Gonzalez-Abad MJ, Alonso Sanz M. Invasive streptococcus pyogenes infections (2011–2018): EMM-type and clinical presentation. An. Pediatr (Engl. Ed.) 2020;92(6):351–358(in Spanish). Solomon L, Warwick D, Nayagam S. Apley's system of orthopaedics and fracture. 9th ed: apley's system orthopaedics and fractures; 2013. Kaplan SL. Osteomyelitis in children. Infec Dis Clin N Am 2005;19(4):787-vii. Zhan, C, B, Du, J, Chen, L. Clinical analysis of 17 cases of neonatal osteomyelitis: a retrospective study. Medicine (Baltimore) 2019;98(2). Lidia D, Nunzia D. Neonatal osteomyelitis.10.5772/interchopen.69675. Offiah AC. Acute osteomyelitis, septic arthritis and discitis: differences between neonate and older children. European Journal of Radilology 2006;60(2):221–232. Fisher RG. Neonatal osteomyelitis. NeoReviews 2011;12:374. Hitchins, Margaret, O'Mara, Keliana. Treatment of persistent methicillin-susceptible staphylococcus aureus bacteremia and presumed osteomyelitis with oxacillin and ertapenem in a premature neonate. The Journal of Human Pharmacology and Drug Therapy 2023;43(1):96.