| Objectives The objectives were:1) to evaluate and classify infants at risk for congenital syphilis (CS);2) to identify the risk factors contributing to CS, including related maternal socioeconomic status and prenatal care for maternal syphilis;3) to present the clinical characteristics of CS;4) to present the treatment of infants at risk for CS and short term prognosis until discharge.Methods The medical charts of infants at risk for CS from1999-2009in Children’s Hospital of Fudan University were retrospectively reviewed. The collected information included maternal characteristics (age, occupation, residency status, history of miscarriage, characteristics of prenatal care for maternal syphilis), infants’ basic characteristics and clinical information. The study evaluated and categorized infants at risk for CS into CS cases, other infants at risk for CS according to US CDC’s surveillance definition of CS; CS cases with abnormal clinical characteristics (including characteristic skin rash, hepatomegaly, splenomegaly, abnormal long bone X ray, positive19S-lgM in serum) were designated as clinical CS cases. Through comparing clinical CS cases and other infants (including other CS cases and other infants at risk for CS) born in Shanghai, maternal characteristics related to CS were explored. Clinical characteristics of clinical CS cases and cases with positive19S-lgM in serum were defined, respectively. The treatment of infants at risk for CS, and short term change of RPR titer until discharge were also analyzed.Results (1) The evaluation and classification of infants at risk for CS from1999-2009: A total of1670infants at risk for CS were referred to the hospital from1999to2009. The number of infants at risk for CS increased rapidly,10in1999,92in2004, and to368in2009. Among the1670infants at risk for CS,58.3%(973/1670) were admitted within1days after birth,3.9%(65/1670) were admitted over28days;12.6%(208/1650) were preterm,10.6%(177/1637) had low birth weight,55.8%(738/1670)were delivered by cesarean section. Of the1670mothers of infants at risk for CS, only30.2%(503/1670) screened syphilis before pregnancy or during the first trimester of pregnancy; only25.8%(433/1670) received penicillin treatment4weeks before delivery. For infants at risk for CS, the rate was13.5%(225/1670) for abnormal physical examination,11%(157/1422) for positive19S-lgM in serum,13.2%(208/1578) for abnormal long bone X ray. According to US CDC’s CS surveillance definition,1319of the1670infants at risk for CS were categorized as CS cases, including407as clinical CS cases, the other351as other infants at risk for CS.(2) Related maternal characteristics for CS in Shanghai (1999-2009):among the1670infants at risk for CS,1598ones born in Shanghai were included in the analysis, including383clinical CS cases,1215other infants. Compared with other infants, mothers of clinical CS cases were more likely to be younger than25years old, unemployed, migrant, primiparous, to screen syphilis after delivery, to have RPR titer≥1:8, or positive19S-IgM. Compared with mothers with migrant resident status, mother with local resident status were more likely to have adequate treatment of maternal syphilis (penicillin four weeks before delivery).(3) Clinical characteristics of clinical CS cases:Among the407clinical CS cases,363were neonates,44were postneonates. Compared with neonates with CS, the postneonatal ones had higher proportion of hepatomegaly (65.1%vs.25.1%, p<0.001), splenomegaly (39.5%vs.15.8%, p=0.001), PRP titer≥1:8(59.1%vs.39.7%, p=0.014), positive19S-IgM in serum (67.7%vs.42.3%, p=0.005), anemia (72.7%vs.19.0%, p<0.001), and elevated CRP (53.1%vs.26.9%, p=0.002). Compared with term neonates with clinical CS, the preterm ones had higher proportion of hepatomegaly (40.2%vs.18.4%, p<0.001), splenomegaly (28.9%vs.10%, p<0.001), PRP titer≥1:8(70.8%vs.27.7%, p<0.001), positive19S-lgM in serum (70.4%vs.31.6%, p<0.001), anemia(29.9%vs.14%, p=0.001), thrombocytopenia (38.1%vs.8.9%, p<0.001), elevated CRP (51.7%vs.16.7%, p<0.001), and abnormal long bone X ray results (60.2%vs.46.6%, p=0.025).(4) Clinical characteristics of cases with positive19S-lgM in serum:Among the1670cases at risk for CS,130neonatal cases with positive19S-lgM in serum were included in the analysis, including58preterm ones and72full term ones. Compared with term neonates with CS, the preterm ones had higher proportion of characteristic skin rash (36.2%vs.9.7%, p<0.001), hepatomegaly (51.7%vs.25%, p=0.02), splenomegaly (32.8%vs.15.4%, p=0.02), PRP titer≥1:8(96.6%vs.70.8%, p<0.001), thrombocytopenia (43.1%vs.23.6%, p=0.018), elevated CRP (65.5%vs.36.5%, p=0.002), and abnormal long bone X ray results (46.4%vs.20.9%, p=0.003). Less mothers of preterm neonates with CS received treatment for syphilis (15.5%vs.40.3%, p=0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31%vs.12.9%, p=0.012).(5) Treatment of infants at risk for CS and short term change of RPR titer until discharge:64.1%(1045/1670) infants received10-14days treatment of penicillin. In2009,368infants at risk for CS were referred to the hospital; the average fee for hospitalization was7087yuan for clinical CS cases,4773yuan for other CS cases, and4218yuan for other infants at risk for CS. A total of388infants at risk for CS had a second RPR test before discharge,28.4%(110/388) were clinical CS cases, and19.9%(61/307) were with positive19S-lgM in serum.84.8%(329/388) ones had the test between7days and30days after admission.10.4%(23/221) with negative RPR titer had a positive one at the second time,58.6%(58/99) with RPR titer<1:8had a negative one at the second time, and45.6%(31/58)with RPR titer≥1:8had RPR titer<1:8or a negative one at the second time.Conclusions (1) the number of infants at risk for CS increased rapidly from1999to2009. However, the number of clinical CS cases did not increase rapidly accordingly, it indicated the importance of the policy of screening all the pregnancy women; the prenatal screening and treatment of maternal syphilis still should be strengthened.(2) CS was related to the poor socioeconomic status, improper prenatal care for maternal syphilis, and active maternal syphilis.(3) post-neonatal clinical CS cases had more abnormal clinical features than neonatal CS cases, preterm clinical CS cases had more abnormal clinical features than term ones. There were difficulties in the clinical diagnosis of CS, especially for bone syphilis, neurosyphilis evaluation.(4)Preterm neonates with positive19S-lgM had more clinical evidences of infection and suffered more than term ones,(5) The diagnosis, evaluation, treatment and prevention of CS need to be proved; corporation of multi departments needs to be strengthened, including neonatology, obstetrics, health department if to elimination of CS. |
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