Are long bone radiographs necessary in neonates suspected of having congenital syphilis?

The frequency of appendicular bone abnormalities was prospectively evaluated in 93 newborns suspected of having congenital syphilis. The evaluation of each newborn included prenatal history, physical examination, serologic tests, and long bone radiography, which was performed during the first week after birth. In all patients, results of at least one serologic test for syphilis were positive or proof of syphilis was found at autopsy. In 75 patients (81%), the long bone radiographs were normal. The nonspecific finding of lucent metaphyseal bands was the most common abnormality on long bone radiographs; only five newborns had more specific changes of syphilis in the metaphyses and periosteal reaction. In view of the low frequency of relatively specific radiographic findings in the long bones, the authors recommend that long bone radiography not be a part of the routine evaluation of full-term newborns suspected of having congenital syphilis.