(98) Multi-center Comparison of Resource Utilization and Outcomes of Neonates with Congenital Syphilis in Greater Chicago Area

Background: Cases of congenital syphilis in the US have increased by 754.8% from 2012 to 2021. This increase is reflected in the rising rates of syphilis in females of reproductive age that disproportionally affects underserved and minority patients. Diagnosis of congenital syphilis is complicated by the fact that it is difficult to interpret reactive serologic tests due to placental transfer of antibodies. Per CDC recommendations, treatment decisions are therefore guided by an extensive diagnostic workup including maternal labs, maternal treatment, presence of clinical, laboratory, or radiographic evidence of syphilis in the neonate, and comparison of maternal to neonatal RPR or VDRL titers.

Objectives: This data was collected as part of an ongoing study comparing clinical utilization and outcomes among infants with congenital syphilis between hospitals in Chicago. These hospitals have varying diagnostic practices. This study aims to address differences in outcomes, resource utilization, and costs between institutions.

Design/Methods: This is a retrospective study looking at over 200 mother-infant dyads. While the study is ongoing, the data presented explores the demographics of the dyads and initial outcomes of infants in the Comer Children’s Hospital arm.

Results: 50% of mothers in the study were on Medicaid, and 88% of the mothers were Black. 79% of infants in the study were on Medicaid, and
89% of the infants were Black. 26% of infants received one day of penicillin. 8% of infants received 10 days of penicillin, and the mean days of penicillin received by the infants was 1.7. 40% of infants had a follow-up appointment schedule in the EMR, but only 23% of infants had follow-up RPR labs. 0 neonates had a long bone radiograph completed, 14 neonates underwent auditory testing, 14 underwent vision testing, and 12 neonates underwent lumbar puncture with 1 having positive CSF VRDL.

Conclusions: Given the disproportionate effect of syphilis on underserved and minority communities and the burden of treatment on medical systems and patients, it is crucial to study clinical utilization and outcomes. At Comer Children’s Hospital, neonates with positive titers do not routinely undergo extensive diagnostic work-up that would otherwise include long bone radiographs, lumbar puncture, vision/auditory testing which is incongruent with current CDC recommendations. We hypothesize that neonates with congenital syphilis at Comer have similar outcomes despite more limited diagnostic evaluation. Further work comparing these diagnostic and treatment practices is warranted to better understand how to optimize congenital syphilis care.