Abstract
BACKGROUND: Neonatal osteomyelitis is rare, and rib involvement is even more uncommon. Early diagnosis is challenging due to nonspecific clinical signs and the limitations of conventional imaging methods. OBJECTIVE: To describe a case of neonatal rib osteomyelitis and highlight the diagnostic utility of point-of-care ultrasound in its early detection. METHODS: A case of a 25-week preterm neonate with a localized thoracic swelling was investigated. Diagnosis was made using point-of-care ultrasound, which identified a fluid collection and cortical disruption, while radiography showed no abnormalities. A review of the literature was conducted to compare findings with other reported cases. RESULTS: The neonate was diagnosed with rib osteomyelitis caused by Staphylococcus aureus and treated with a 6-week course of targeted antibiotics. The infant made a full recovery. A literature review revealed three other cases of neonatal rib osteomyelitis, all associated with S. aureus, with localized swelling as the primary clinical symptom. Imaging results varied, with ultrasound proving to be more sensitive than radiography in early detection. None of the cases underwent magnetic resonance imaging. CONCLUSIONS: Neonatal rib osteomyelitis, though extremely rare, should be considered in neonates presenting with localized chest wall abnormalities. Point-of-care ultrasound is a valuable diagnostic tool, enabling early detection and potentially improving outcomes through timely intervention.