**Author details**

38 Neonatal Bacterial Infection

[18,48,50].

treatment.

**7. Prognosis** 

**8. Conclusion** 

**6. Treatment** 

methylene diphosphonate accumulates in areas of increased bone turnover and is for now the preferred agent of choice for radionuclide bone imaging. In neonates bone scintigraphy is the subject of controversy: only a few reports support its use and have shown that sensitivity is much lower, than in older infants because of poor bone mineralization

Successful cure of osteomyelitis during the newborn period is dependent on a fast and true diagnosis and sufficient treatment. Empirical selection of antibiotic therapy depends on the age and the clinical situation of the infant. Antimicrobial therapy should be started as soon as the diagnosis is made and directed against the most common bacterial isolates responsible for hematogenous osteomyelitis according to age group. Delay in therapy commencement increases the risk for complications. If a definitive organism is isolated,

For neonates an empiric regimen should include excellent coverage against S. aureus, group B streptococcus and enteric gram-negative bacteria, thus consisting of a third-generation cephalosporin (cefotaxime) plus an antistaphylococcal agent (amoxicillin). Infants at risk for hospital-acquired infection (methicillin-resistant or coagulase negative Staphylococcus

Duration of treatment depends on the extent of infection, the clinical response and the presence of underlying risk factors [51]. In the case of unifocal osteomyelitis continuation of treatment for six weeks and in the case of complex disease, defined as multifocal, significant bone destruction, resistant unusual pathogen, septic shock, continuation for more than six weeks to months might be required. Antimicrobial treatment is frequently administered intravenously for two to three weeks and then switched to oral medication [52]. Surgery is indicated to drain acute abscesses or when no improvement is achieved with antibiotic

Several studies have documented poor outcome even with modern treatment facilities. In neonates the reported incidence of permanent sequelae varies from 6% to 50% [2,11]. Neonatal osteomyelitis can lead to permanent joint disabilities, disturbances in bone growth secondary to damage to the cartilaginous growth plate, limb-length discrepancies, arthritis,

Neonatal osteomyelitis, although a rare complication, remains a diagnostic and therapeutic challenge and poses the infant at high risk for long term morbidity. Osteomyelitis should be considered in newborn infants presenting with clinical signs of sepsis, but lacking an

antimicrobial treatment should be accordingly adjusted.

aureus) should receive vancomycin instead of amoxicillin.

decreased range of motion and pathologic fractures [51].

Ursula Kiechl-Kohlendorfer and Elke Griesmaier *Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria* 
