Неонатальная и детская медицина

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41-Year Systematic Literature Review of Early Infancy Osteomyelitis: What Have We Learned with the Entry of MRI into Diagnostic Protocol?

Barbara Minkowitz, Emily Lillie, Elizabeth Baorto, Robyn Murphy, Jennifer R Ristic and Zachary Cherna

Background: A 41-year systematic literature review of early infancy osteomyelitis was performed. Observations were made regarding variables related to the diagnosis and treatment of the disease. We asked: 1) since magnetic resonance imaging (MRI) technology was introduced into diagnostic protocol in 1998, has there been an improvement in diagnosis and outcomes? 2) What additional aspects of the disease and diagnostic protocol may be affecting outcomes?

Methods: We performed a literature search and divided 36 cases into 2 groups; 1) all young infancy osteomyelitis cases before first reported MRI usage in 1998, 2) all young infancy osteomyelitis cases after first reported MRI usage in 1998. 34 cases from the literature and 2 of our cases were reviewed.

Results: Analysis of key variables related to diagnosis and treatment did not indicate statistically significant differences between the 2 groups. The following symptoms were common among both groups: pseudoparalysis in 28 (77.8%) and swelling in 22 (61.1%) patients.

Conclusion: Despite the benefits of MRI there have been few outcome changes with respect to the diagnosis and treatment of early infancy osteomyelitis. Early diagnosis is crucial; therefore, appropriate modifications to current diagnostic protocol may be warranted. Improvement may be possible if clinicians adopt a high index of suspicion for osteomyelitis and a low threshold of obtaining MRI.