One night in December 2019, my 10-month-old Erbao’s body temperature suddenly rose to over 39°C. Despite multiple experiences dealing with nighttime fevers as an older child, I still can’t calm down.
After reading several popular science articles, it is basically recommended that physical cooling should be observed below 38.5 °C, and medicines may be required to cool down under the guidance of a physician if the temperature is above 38.5 °C. So we rushed to take the child to the emergency room.
The road to reducing fever is very tortuous
The medical resources in the city where we are located are tight, especially in the tertiary children’s hospital. At night, the emergency line is basically about 5 hours, and all children have fever.
Because the fever baby is very uncomfortable, I have been soothing her with breast milk during the waiting time. After finally waiting for us, the emergency doctor listened to the heart and lungs, looked at the throat, asked about appetite and urine, and checked the results of the blood draw. He thought it was an upper respiratory tract infection, and prescribed antipyretics and antibiotics to take home.
After I went home and took antipyretics, the child’s body temperature was normal for 3 to 4 hours, and then the fever started again. Dad mobilized his medical reserve knowledge and judged that antibiotics should be taken for another two or three days to see the effect.
Next, my dad and I insisted on going to work, my grandparents took care of the baby during the day, and we switched to ourselves at night. When changing shifts, my grandmother didn’t mention it, saying that the baby seems to be a little reluctant to move with one leg. I didn’t take it seriously at the time. I didn’t think about the leg problem at all. I told my grandma that the baby was having a fever and would be lethargic. Moreover, I just started learning to walk at 10 months, so it’s normal not to move.
During the two or three days of taking antibiotics, the baby burned to nearly 40°C almost every night. The situation did not improve, and we ran to the emergency room again late at night. The emergency doctor changed someone, and the diagnosis was the same as last time, only this time the antibiotics were upgraded.
After another round of antipyretics and antibiotics, the baby still has a fever of nearly 40°C every night , but it is normal to eat and drink during the day.
My dad and I couldn’t bear this unexplained fever. Considering the limited emergency conditions, we might not have seen it carefully, so we took leave and hung up the daytime internal medicine specialist clinic, but the examination content and treatment methods were no different from before. .
During the 11 days of the disease, we went to the emergency department 3 times and the specialist clinic 2 times. The baby has been having a fever and stopped for a while. The fever was 40℃ . Breast milk remains calm. When she is not burning, she is no different from a normal 10-month-old child, but she just doesn’t like to stand, and her grandma still takes her out to play.
Finally, the baby has no fever for 2 consecutive days. I naively thought she was all right.
Two days later, in the middle of the night, I changed my baby’s diaper. I habitually pulled her legs, but her left leg retracted abnormally, and she cried in her sleep. I realized that the child’s left leg was abnormal. Thinking of the fact that my grandmother mentioned that my child doesn’t like to stand, I can no longer sleep, and I immediately hung up the number of the orthopaedic department the next day on my mobile phone.
There was only an afternoon number that day, so I simply asked for leave to take care of my baby at home. I was so anxious that I couldn’t go to work normally. I carefully observed this morning and found that the 10-month-old baby likes to crawl, but when crawling, it is obviously crawling forward on one side. When I hold her up and stand, her left leg will not touch the ground . My heart was uncontrollably clenched into a ball.
Finally made it to the afternoon outpatient clinic, I watched the doctor put the baby on the bed and gently pulled her legs. Her left leg has been retracted, the symptoms are very obvious, and the doctor’s expression is very solemn. It was almost time to get off work at that time, but the doctor prescribed an urgent B-ultrasound and CT.
The B-ultrasound results came out soon, and the baby’s dad came over after get off work. The doctor said that there is no need to wait for CT. According to the B-ultrasound, it can basically be judged that it is septic hip arthritis , and it needs to be operated immediately. The sooner the better.
I didn’t expect that it would take nearly 3 months from the day we stepped into the orthopedic clinic to when we came out.
Late at night, emergency surgery begins
I vividly remember that it was 8pm when we finished the hospitalization that day.
After being admitted to the hospital, the doctor asked to fast immediately to prepare for the operation. Facing the anxious baby dad and me who was crying all the time, the doctor explained the condition to us very conscientiously. Doctors refer to this disease as “hip” for short. In layman’s terms, bacteria invade the hip joint and the joint cavity becomes suppuration. Generally, the cause of this disease is that trauma causes bacteria to invade the body. The bacteria travel through the blood, stay in the loose joint capsule cavity and gather, and eat the joint. Fever is just one of the symptoms of the disease, and imaging tests can show significant localized fluid accumulation, swelling, and joint dislocation. Internationally, there is indeed conservative treatment, which kills bacteria through continuous antibiotic treatment, but the cycle is long and the effect is uncontrollable. If the conservative treatment does not work well, surgery should be considered.
The doctor was very decisive and suggested immediate surgery. The surgical method was to cut the joint cyst cavity, directly extract the pus, and insert a drainage strip to drain the pus, and simultaneously cooperate with antibiotic anti-infective treatment . The doctor said that under normal circumstances, the treatment time is 2 to 3 months. Parents should be mentally prepared. As long as they cooperate actively, the prognosis is usually good, but gait correction may be required.
In fact, the specific surgical plan is no longer important. At that time, I only had one thought, which was the doctor’s sentence: the sooner the better, there is no need to struggle .
The fatigue and worry of the past half month have made my eye sockets sink deep, and the thought of having surgery at such a young age breaks my heart.
While waiting for the operation, I had no way of comforting myself. I just knelt on the side of the hospital bed secretly, praying that the operation of the baby would be safe and that there would be no sequelae.
The surgery was scheduled for midnight. The nurse picked up the sleeping baby, and I saw her small body lying under the green surgical cloth, her tender shoulders exposed. I am a very unsatisfactory mother. I have been unable to control my tears. I feel that I have not taken good care of her, and I can’t help but blame myself.
When the operation was over 2 hours later, the doctor instructed me to hold her in the most comfortable position for her. So during the recovery from anesthesia, she lay naked on my chest and fell asleep quietly.
Changing dressings and injections is also a painful torture
On the second day of the operation, the attending doctor took the CT results of the previous day and explained the baby’s condition carefully: “The hip joint is swollen and the joint has been subluxed. ” pushed out. If left untreated, walking limitation, known as lameness, can occur.
The treatment that followed was simple and cruel. Every day is to change the dressing and infusion, and then draw blood every two or three days to confirm whether there is liver damage and monitor the bacteria in the body.
The surgical incision is open. Every morning, the doctor takes the baby to the dressing room, pulls out the drainage strip, observes the condition of the pus from the drainage strip, and then inserts a new drainage strip. This operation lasted for 2 months, and I had no way to participate, because when I thought that the incision that went deep into the bone had to be stuffed with gauze, I was so distressed that I couldn’t hold her there and let the doctor operate normally.
Then there are injections, just like eating regularly, once in the morning and once in the afternoon. Every time, I pressed her and asked the nurse to stick the needle, sometimes three or four times to find the blood vessel. The baby looked at me and cried piercingly, as if asking “Mom why do you let others bully me”. Almost every time the baby cried until she was sweating, and then she became hoarse. After taking antibiotic injections for a period of time, it was adjusted to oral antibiotics. Fortunately, the baby is very good and cooperates with taking medicine.
In addition, the baby’s blood vessels are very thin, and the indwelling needle for infusion can basically only be used for one day, and it can be used for two days if you are lucky. Little hands, little feet, forehead, basically all the places on her body that can be used are used.
My baby dad and I have been wondering where the bacteria come from. During that time, the baby’s father kept asking what the grandparents had eaten for the baby, whether they washed their hands at any time, and whether the baby ate their hands, but never found an answer. Even doctors say it’s pointless to ask where the bacteria come from now, because it’s hard to come up with an answer.
The doctor also did a bacterial culture for the baby to see if the antibiotic needed to be adjusted by the type of bacteria. It may take half a month or longer before it is confirmed that it is Staphylococcus aureus , so the antibiotics are changed from broad-spectrum to narrow-spectrum. The doctor said that it may be because antibiotics have been used before to kill some bacteria, so the culture will be more difficult.
During the hospitalization, the doctor also invited the immunologist for consultation and screened the baby for immune system diseases. The results were good. Maybe this “hip change” was really just an accident.
In addition to conventional treatment, “postoperative traction” and “frog hug” are also important parts of treatment.
The 24-hour “traction” is to straighten the leg through continuous stretching, which acts as a fixation, and this fixation can relieve pain to a certain extent. The specific operation is that the child lies flat on the bed, wraps the leg of the operation with a towel, ties one end of the long line to the leg, and the other end is tied with a weight similar to a scale or weight provided by the hospital, and passes through the grille of the bed. hang down. At the beginning, of course, it was very unaccustomed. The baby couldn’t turn over freely, couldn’t crawl, and his legs were pulled 24 hours a day. Over time, she got used to it.
Half a month after the operation, the doctor said that the “frog brace” can be worn. The brace is mainly used to fix the bone joint and avoid joint wear. It is best to wear it 24 hours a day and stick to it for half a year. At first, the baby was definitely reluctant, but she adapted very quickly, and after half a year, she could crawl around wearing a brace. Therefore, during the prime time for ordinary babies to learn to walk, my baby is sitting or lying in frog pose.
Finally, the baby went home with the brace!
Everything went smoothly after that. When the epidemic broke out during the Spring Festival in 2020, we had already spent nearly 3 months in the hospital. After 3 consecutive days of blood sampling and observation, coupled with imaging studies indicating that the joint has been reset, the treatment is in good condition. The doctor said that we can be discharged from the hospital! Finally, the baby went home with the brace!
During my time in the hospital, I basically lost 3 pounds a week. As a mom, I was extremely anxious and worried about my baby’s prognosis. When he was discharged from the hospital, the doctor also mentioned that if the brace is removed after half a year, there may be problems with the baby’s gait, and gait correction may be required according to the situation .
It was followed by a three-month review, a six-month review, and a one-year review, and the results were excellent. Half a year later, when the stent was removed, the baby was one and a half years old. This time, she started learning to walk again, and she was very efficient. She could walk swishly soon .
In the orthopaedic inpatient department, I met babies with the same disease. I wrote down the history of the baby’s illness and treatment. I want to remind the majority of parents that a baby who can’t speak should not only see a doctor when he is sick, but also observe whether his/her living habits have changed . A physical examination by a doctor is also very important. Many diseases can be treated earlier if they are diagnosed earlier.
Doctor Reviews
Wang Qingyu | Attending Physician, Orthopaedic Medical Center, Second Hospital of Jilin University
Septic arthritis accounts for about 21% of childhood bone and joint infections, and 43% of septic arthritis affects the hip joint. Septic arthritis of the hip (SAH) is a serious infectious disease caused by bacterial infection of the hip joint. Literature shows that the incidence of SAH is about 5/10000 to 12/10000, and there is no gender difference. The disease is common in younger children, such as newborns, infants, and children aged 2 to 3 years.
Limitation of motion and local swelling are the most common manifestations of neonatal bone and joint infections. The clinical symptoms of SAH in children mainly include fever, inability to bear weight on the affected limb, and limitation of hip joint movement, especially internal rotation. Some children will maintain the hip joint in flexion, abduction and external rotation voluntarily, because this position can increase the volume of the hip joint capsule and reduce the pain caused by the high pressure in the capsule.
It is worth mentioning that due to the different types, virulence, and quantity of pathogenic bacteria, infants and young children have different physiques and degrees of inflammatory response, plus the application of antibiotics and antipyretic drugs, there may be individual differences in fever . Diagnosis of neonates is difficult, most of them only show refusal to eat, reduced limb activity, crying, fever and systemic symptoms may be mild or even absent, but local swelling, pain, and limited activity are still typical symptoms.
X-rays are a routine adjunct to SAH and can detect soft tissue swelling and advanced joint dislocations. MRI has significant advantages in early diagnosis, showing the extent and location of infection, and guiding treatment. Ultrasonography is a quick, relatively inexpensive test that is especially important for joints such as the hip, where palpation is not possible to determine the presence of fluid. Ultrasound of the hip can detect joint effusion and dilatation of the joint capsule, but cannot distinguish SAH from other noninfectious diseases. When SAH is suspected, physicians may perform an ultrasound-guided hip puncture.
Early diagnosis, timely opening of joint drainage and use of effective antibiotics are the keys to the treatment of this disease. Prompt surgical treatment can reduce the occurrence of serious complications such as avascular necrosis of the femoral head and permanent articular cartilage damage. Open arthrotomy is currently the most mainstream surgical method, and alternative methods include arthroscopic surgery and ultrasound-guided continuous hip puncture. But in some cases, open surgery is the only option.
At present, there is no unified standard for the selection of SAH antibiotics in children, the course of treatment, the time of transition from intravenous to oral administration, and the timing of antibiotic application. Clinically, bone and joint infections generally require antibiotics for 4 to 6 weeks . In addition to routine intravenous antibiotics, peripheral puncture central catheters (PICC) can also be used. PICC can not only reduce the pain stimulation and fear caused by repeated puncture in children, but also ensure that children can complete the infusion plan accurately and timely.
Antimicrobial therapy should be administered as soon as possible after obtaining blood and synovial fluid for culture. Antibiotics that are effective against common pathogens can be used empirically before the culture results are obtained, and sensitive antibiotics can be selected after the culture and drug susceptibility results are obtained.
Finally, in addition to helping their children recover and exercise, parents also need to keep in touch with doctors and actively review the recovery of the hip joint .
Personal experience sharing does not constitute diagnosis and treatment advice, and cannot replace a doctor’s individual judgment on a specific patient. If you need to seek medical treatment, please go to a regular hospital.
Author: Bi Bi
Editor: Bai Ji, Li Xiaoqiu
Cover image: pixabay
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