Clinical characteristics, pathogenesis, treatment, and prognosis of bone and joint infections in neonates: a single-center report of 20 cases

Background To analyze the clinical characteristics, management, and outcomes of neonates with bone and joint infections (BJIs) to improve early diagnosis and guide clinical decision-making. Methods We performed a single-center, retrospective review of 20 neonates (aged ≤ 35 days) hospitalized with BJIs between 2017 and 2025. Data on demographics, clinical presentation, laboratory and imaging findings, treatment, and outcomes were collected and analyzed. Results The mean age was 21.2 days, and 65% of the neonates were male. Pseudoparalysis was the most common presenting symptom (observed in 95% of cases). Pathogens were identified in 14 of the 20 cases (70%), with Staphylococcus aureus being the most prevalent (identified in 11 patients, 55%). Concurrent bone and joint infections were observed in 65% of the patients. Ultrasound demonstrated a high detection rate (95%). Surgical drainage was performed in 12 patients (60%), who presented with significantly higher C-reactive protein levels and a higher culture-positive rate than did the nonsurgical group. With one patient lost to follow-up, data were available for 19 patients, of whom five (26.3%) experienced complications. Conclusions Neonatal BJIs often present with nonspecific signs, among which pseudoparalysis is a key indicator. Ultrasound is a sensitive, first-line imaging tool. Early surgical intervention should be considered for patients with concurrent arthritis and significantly elevated inflammatory markers, as it aids in pathogen identification and infection control.