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Management of Infants Born to Pregnant Women with Reactive Syphilis Serology: Resource Saving from Using the Current
Patricia Lima Furtado Lofiego1, Alena Tse-Chang1,2, Jennifer Gratrix3
1Alberta Health Services, Edmonton, Alberta, Canada.
Insights
Adopting Centers for Disease Control (CDC) guidelines for treating infants with congenital syphilis could save significant healthcare resources. Applying these guidelines could reduce NICU stays, central line use, and invasive procedures, lowering costs.
Area of Science:
- Neonatalogy
- Pediatric Infectious Diseases
- Public Health
Background:
- Congenital syphilis admissions to Canadian neonatal intensive care units (NICUs) are increasing.
- This rise strains NICU bed capacity and resource utilization.
- Current treatment protocols may not align with updated evidence-based guidelines.
Purpose of the Study:
- To evaluate the impact of Centers for Disease Control (CDC) guidelines on resource utilization for infants with congenital syphilis.
- To compare the resource demands of a single-dose intramuscular benzathine penicillin G (BPG) regimen versus a 10-day intravenous penicillin G (PG) course.
- To estimate potential healthcare savings by applying CDC guidelines in Canadian NICUs.
Main Methods:
- Retrospective cohort study of infants born to mothers with reactive syphilis serology admitted to two Level 2 NICUs in Edmonton, Alberta, over 2 years.
- Data extraction on key NICU resources used for congenital syphilis management.
- Estimation of resource utilization under current CDC guidelines for the study cohort.
Main Results:
- Of 49 infants studied, 42 received a 10-day intravenous penicillin G (PG) course.
- 50% of these infants (21/42) met CDC criteria for a single-dose intramuscular benzathine penicillin G (BPG).
- Applying CDC guidelines could have saved 244 hospital days, 128 central line days, 168 antibiotic days, 23 X-rays, and 17 lumbar punctures, totaling an estimated $263,000.
Conclusions:
- Current CDC guidelines could allow for single-dose BPG treatment in half of infants managed with a 10-day PG course.
- Implementing CDC guidelines can significantly conserve healthcare resources and reduce hospital costs.
- Adherence to CDC guidelines can decrease NICU length of stay, central line use, and invasive procedures for congenital syphilis management.
Objective:
There has been a marked increase in the number of infants admitted to neonatal intensive care units (NICUs) in Canada for treatment of congenital syphilis. We studied the impact on resource utilization from using the Centers for Disease Control (CDC) guidelines that allow use of a single-dose intramuscular benzathine penicillin G (BPG), as compared with 10-day course of intravenous penicillin G (PG), in infants considered at low risk for congenital syphilis.
Study Design:
This was a retrospective cohort study enrolling infants born to mothers with reactive syphilis serology and admitted for management to two Level 2 NICUs in Edmonton, Alberta, Canada, over a 2-year period. Data were extracted for key NICU resources that are used in managing these infants. We then estimated the resources that would be utilized if the entire cohort was managed per the current CDC guidelines.
Results:
Forty-nine infants met the study criteria of which 42 were treated with 10-day course of PG. Of these 42 infants, 21 (50%) met the CDC criteria for a single dose of BPG. The use of the CDC criteria to manage this cohort could have avoided 244 hospital days, 128 central line days, 168 antibiotic days related to congenital syphilis treatment, 23 long bones X-rays, and 17 lumbar punctures, for an estimated savings of CDC $ 263,000 to the provincial health system.
Conclusion:
Using the current CDC guidelines, half of the infants exposed to maternal syphilis and treated with a 10-day course of PG in our cohort could have been managed with a single dose of BPG, resulting in a significant saving of health care resources and in hospital costs.
Key Points:
· Cases of congenital syphilis have risen sharply in parts of Canada.. · Frequent admissions of such cases in the Canadian NICUs have aggravated bed capacity challenges.. · Applying the current CDC guidelines could reduce the NICU length of stay, the use of central lines, and other invasive procedures in this population..
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