Neonatal osteomyelitis: A case series


  • Parveen Kumar Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
  • Ankur Bhardwaj Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India
  • Anil Agarwal Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
  • Divyamedha Agarwal Department of Anaesthesia, Chacha Nehru Bal Chikitsalaya, New Delhi, India



Osteomyelitis, Septic arthritis, Neonate, Sepsis, Bones


Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints.

Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years.

Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.


Download data is not yet available.


Metrics Loading ...


Asmar BI. Osteomyelitis in the neonate. Infect Dis Clin North Am. 1992; 6:117-32.

Riise OR, Kirkhus E, Handeland KS, Flato B, Reiseter T, Cvancarova M, et al. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr. 2008; 8:1.

Fisher RG. Neonatal osteomyelitis. NeoReviews. 2011; 12:e374-80.

Blickman JG, van Die CE, de Rooy JW. Current imaging concepts in pediatric osteomyelitis. Eur Radiol. 2004; 14:L55-64.

Offiah AC. Acute osteomyelitis, septic arthritis and discitis: differences between neonates and older children. Eur J Radiol. 2006; 60:221-32.

Gutierrez K. Bone and joint infections in children. Pediatr Clin North Am. 2005; 52:779-94.

Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, et al. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline. JAMA. 1991; 266:1246-51.

Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med. 2014; 370:352-60.

Chou AC, Mahadev A. Acute bacterial osteomyelitis in children. J Orthop Surg (Hong Kong). 2016; 24:250–2.

Zhan C, Zhou B, Du J, Chen L. Clinical analysis of 17 cases of neonatal osteomyelitis: A retrospective study. Medicine. 2019; 98:e14129.

Gao Y, Liu R, Rai S, Liang Q, Liu Y, Xiao X, et al. Is early surgical intervention necessary for acute neonatal humeral epiphyseal osteomyelitis: A retrospective study of 31 patients. Child. 2022; 9:527.

Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study. J Med Assoc Thai. 2011; 94:S209-16.



How to Cite

Kumar P, Bhardwaj A, Agarwal A, Agarwal D. Neonatal osteomyelitis: A case series. J Neonatal Surg [Internet]. 2023Jul.26 [cited 2024Jul.22];12:22. Available from:

Most read articles by the same author(s)

1 2 > >>