Acute neonatal osteomyelitis is a challenging disease and its diagnostic is important to avoid comorbidities. Staphylococcus aureus is the most often involved germ. The diagnostic challenge lies in its pauci-symptomatology in the premature infant in contrast to a more obvious clinical presentation in the term infant or child. The risk factors inherent to prematurity are invasive monitoring, repeated blood sampling, prolonged central catheterization, immature immune response and length of hospital stay. We report the case of an osteomyelitis secondary to staphylococcal sepsis in a preterm infant born at 25 weeks and 3 days of gestational age. The diagnosis was made incidentally on an abdominal x-ray. The low parental compliance for the child's follow-up does not allow us to affirm a future without sequelae even if the elements at our disposal at 8 months suggest a favorable outcome. Acute neonatal osteomyelitis remains a difficult but crucial diagnosis for the future development of the child.
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