Vertebral complications of late-onset neonatal sepsis

Objective. To analyze characteristic features of spinal lesions as a manifestation of late-onset neonatal sepsis. Material and Methods. Medical histories, clinical, and instrumental data of 9 children operated on for consequences of spinal lesions associated with late-onset neonatal sepsis were studied. Design: retrospective clinical study. Level of evidence – IV. Results. Neonatal sepsis occurred at the age of 5 days to 2.5 months after birth. Main clinical manifestations of the disease were caused by pneumonia observed in 7 of 9 children. Spinal lesion was diagnosed within 3–12 months after the disease onset. Its main manifestation was kyphotic deformity caused by the T4–T11 vertebral body destruction. Average age of children at surgery was 13.4 months (range: 7 to 21 months). All patients underwent two-stage surgical treatment includ- ing anterior fusion and posterior instrumentation of the spine. Long-term results were followed for up to 5 years. Conclusion. Spinal lesions as a manifestation of late-onset neonatal sepsis are rare disorders, and are characterized by vast destruction of vertebral bodies and development of paravertebral and epidural abscesses in neurologically intact patients. However, they are diagnosed only after the onset of kyphosis. Verification of spondylitis etiology fails due to the prior mas- sive antibiotic therapy and insufficient examination in the acute phase of sepsis. Surgical treatment of spondylitis caused by late-onset neonatal sepsis is carried out when the infection is under control, and aims at the anterior column reconstruc- tion and the correction of kyphotic deformity.