{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:43Z","timestamp":1756339543848,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,8,11]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>Neonatal osteomyelitis and septic arthritis are rare but serious conditions that can arise in the first few weeks of life. The main risk factors for neonatal bone and joint infections include chorioamnionitis, perinatal asphyxia, prematurity, sepsis, invasive lines and procedures, mechanical ventilation, urinary tract infection and skin lesions. The risk factors related to birth trauma like breech delivery and nerve palsies of the upper extremity have been described but are relatively uncommon. Here, we discuss two interesting but similar cases of osteomyelitis affecting two pairs of twins, where only one of the twins in each pair developed osteomyelitis. The common association between them was breech presentation with difficult extraction.<\/jats:p>","DOI":"10.1136\/bcr-2025-264807","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:15:19Z","timestamp":1756314919000},"page":"e264807","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Twin trouble: osteomyelitis as a complication of abnormal fetal presentation"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8355-4927","authenticated-orcid":false,"given":"Rajarajan","family":"Paulpandian","sequence":"first","affiliation":[{"name":"Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8132-9574","authenticated-orcid":false,"given":"Umamaheswari","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1487-836X","authenticated-orcid":false,"given":"Prakash","family":"Amboiram","sequence":"additional","affiliation":[{"name":"Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhanu Hruday","family":"Koduru","sequence":"additional","affiliation":[{"name":"Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7566-5244","authenticated-orcid":false,"given":"Vahnita","family":"TSV","sequence":"additional","affiliation":[{"name":"Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"2025082710151176000_18.8.e264807.1","doi-asserted-by":"crossref","first-page":"e265","DOI":"10.1542\/neo.25-5-e265","article-title":"Neonatal Osteomyelitis","volume":"25","author":"Gajagowni","year":"2024","journal-title":"Neoreviews"},{"key":"2025082710151176000_18.8.e264807.2","doi-asserted-by":"publisher","DOI":"10.31486\/toj.18.0138"},{"key":"2025082710151176000_18.8.e264807.3","doi-asserted-by":"crossref","first-page":"102095","DOI":"10.1016\/j.epsc.2021.102095","article-title":"Osteomyelitis and septic arthritis in neonatal lupus erythematosus patients","volume":"76","author":"Diana","year":"2022","journal-title":"J Pediatr Surg Case Rep"},{"key":"2025082710151176000_18.8.e264807.4","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s00381-016-3084-4","article-title":"Infected cephalohematomas and underlying osteomyelitis: a case-based review","volume":"32","author":"Staudt","year":"2016","journal-title":"Childs Nerv Syst"},{"key":"2025082710151176000_18.8.e264807.5","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1097\/01.inf.0000168851.56027.3f","article-title":"Fetal breech presentation predisposes to subsequent development of septic arthritis of the hip","volume":"24","author":"Cieslak","year":"2005","journal-title":"Pediatr Infect Dis J"},{"key":"2025082710151176000_18.8.e264807.6","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/01241398-199503000-00007","article-title":"Radial-nerve palsy associated with septic shoulder in neonates","volume":"15","author":"Lejman","year":"1995","journal-title":"J Pediatr Orthop"},{"key":"2025082710151176000_18.8.e264807.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2004.07.006"},{"key":"2025082710151176000_18.8.e264807.8","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1469-8749.1998.tb15401.x","article-title":"Acquired brachial-plexus neuropathy in the neonate: a rare presentation of late-onset group-B streptococcal osteomyelitis","volume":"40","author":"Sadleir","year":"1998","journal-title":"Dev Med Child Neurol"},{"key":"2025082710151176000_18.8.e264807.9","first-page":"449","article-title":"Brachial plexus neuropathy secondary to septic arthritis and osteomyelitis: report of two cases","volume":"35","author":"Wang","year":"1994","journal-title":"Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi"},{"key":"2025082710151176000_18.8.e264807.10","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000014129","article-title":"Clinical analysis of 17 cases of neonatal osteomyelitis: A retrospective study","volume":"98","author":"Zhan","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025082710151176000_18.8.e264807.11","doi-asserted-by":"crossref","unstructured":"Edwards MS , Nizet V , Baker CJ . Chapter 12 - Group B Streptococcal Infections.. In: Remington JS , Klein JO , Wilson CB , et al , eds. Infectious diseases of the fetus and newborn. 7th edn. W.B. Saunders, 2011: 419\u201369.","DOI":"10.1016\/B978-1-4160-6400-8.00012-2"},{"key":"2025082710151176000_18.8.e264807.12","unstructured":"Khalil AH , Elfiky M , Schellerer VS . Newborn with primary sternal osteomyelitis and systemic sepsis caused by X-linked hereditary congenital neutropenia: a case report and literature review. World J Surg Surgical Res 2023;6."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-264807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:15:22Z","timestamp":1756314922000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-264807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":12,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,27]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bcr-2025-264807"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-264807","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}