Approach to Septic Neonate
The scenario is being called down to the NICU to assess a neonate who is not moving a limb.
Right away, think SEPSIS, SEPSIS, SEPSIS, maybe neurological, maybe congenital
– the features of neonatal MSK sepsis can be seen in an infant up to 8-10 weeks old!
– they have an immature immune system – less inflammatory response, and are susceptible to different bugs
* The key is that with their incompetent immune system, they have hematogenous spread to multiple sites, rapidly spreading to bones and joints.
The clinical presentation can be very difficult to sort out – examination of a 3 day old can be confusing.
On the way to the NICU, you should be thinking about ASPIRATING BOTH HIPS. Virtually all other joints can be infected and treated (albeit not optimally) by systemic antibiotics. Not the hips though. The key to this question I’m sure is going to be the identification of the septic hips.
– can bone scan to visualize the different areas of infection.
– most commonly infected with group B strep, gram negatives (especially coliforms), or fungus (Candida)
1. Examine the patient. 2. Aspirate hips 3. To the OR to drain the hips and any other suspicious joints.