Perinatal Treponema pallidum: evidence based guidelines to reduce mother to child transmission

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Infectious Diseases

Background:

• Universal antenatal screening for Treponema pallidum (syphilis) is standard practice in Irish maternity units.
• There has been a documented increase in adult syphilis prevalence within Ireland.
• Syphilis exposure in utero poses significant risks to neonates.

Purpose of the Study:

• To audit the adherence to and efficacy of neonatal management protocols for infants exposed to Treponema pallidum (syphilis) in utero.
• To identify deviations from evidence-based guidelines in the care of exposed neonates.
• To assess the impact of guideline adherence on the overall syphilis screening program.

Main Methods:

• A cross-sectional, retrospective analysis of pregnancies with confirmed positive serology for Treponema pallidum (syphilis).
• Data collected from January 2005 to December 2010 at the National Maternity Hospital, Holles St.
• Infant evaluation and follow-up were guided by an evidence-based algorithm; adherence was assessed.

Main Results:

• Of 41 infants meeting inclusion criteria, only 21 (51%) were accurately allocated and assessed according to the algorithm.
• A significant proportion, 15 infants (36%), experienced incorrect application of the management algorithm.
• 5 infants (12%) received only a partial assessment, indicating inconsistent care.

Conclusions:

• There is a common failure to adhere to evidence-based neonatal management guidelines for syphilis-exposed infants.
• Inconsistent application of established protocols undermines the effectiveness of universal antenatal syphilis screening programs.
• Improved adherence to guidelines is crucial for optimizing neonatal outcomes and public health efforts against congenital syphilis.