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Absence of lower extremity ossification centers in term infants with congenital syphilis
T L Levin1, M Schulman, P Zieba
1Department of Radiology, Bronx Municipal Hospital Center, Albert Einstein College of Medicine, N.Y. 10461.
Insights
Congenital syphilis significantly delays skeletal maturation in term infants, with over 30% showing absent lower extremity ossification centers. This radiologic finding suggests systemic infection impacts bone development in newborns.
Area of Science:
- Pediatric Radiology
- Neonatal Infectious Diseases
- Skeletal Dysplasias
Background:
- Congenital syphilis can manifest with bony abnormalities.
- These abnormalities are attributed to active disease or bone's response to systemic illness.
Purpose of the Study:
- To evaluate the presence of secondary ossification centers in the distal femur and proximal tibia in term infants with congenital syphilis.
- To identify other bony abnormalities associated with congenital syphilis in neonates.
Main Methods:
- Retrospective analysis of anteroposterior lower extremity radiographs from 85 term infants with presumptive congenital syphilis.
- Assessment for distal femoral and proximal tibial secondary ossification centers and other bony abnormalities.
- Comparison with radiographs from 12 term infants without congenital syphilis.
Main Results:
- Absence of both proximal tibial and distal femoral ossification centers in 9 of 85 infants.
- Isolated absence of the proximal tibial center in 26 of 85 infants (30.6%).
- Metaphyseal lucent bands observed in 21 of 85 infants; periosteal new bone formation in 2.
Conclusions:
- Delayed skeletal maturation, specifically absent lower extremity ossification centers, is significantly prevalent in term infants with congenital syphilis.
- This finding contrasts with standard reports of near-universal ossification at term.
- The observed delay in skeletal maturation may indicate systemic infection impacting bone development in neonates.
Abstract:
Radiologic evaluation is valuable for confirmation of congenital syphilis. Bony abnormalities are thought to be secondary to active disease or a growth response of bone to systemic illness. Anteroposterior lower extremity radiographs of 85 euthyroid term infants (> or = 38 weeks' gestation; mean weight, 3244 gm; range, 1940-4380 gm) with presumptive congenital syphilis were evaluated for the presence of the distal femoral and proximal tibial secondary ossification centers and other bony abnormalities. Both proximal tibial and distal femoral ossification centers were absent in only 9 of 85 infants with syphilis; the proximal tibial center was absent in 26 of 85 (total 30.6%; 95% confidence limits 0.2 to 0.4). This observation is significant at the p < 0.01 level by chi-square analysis with use of historical controls. Periosteal new bone formation was seen in 2 of 85 infants. Metaphyseal lucent bands were present in 21 of 85 infants, 8 of whom also had absent lower extremity ossification centers. For comparison we reviewed lower extremity radiographs from 12 term infants without congenital syphilis. Ossification centers were absent in one growth-retarded infant, and metaphyseal lucent bands were found in one infant. Although standard texts report nearly universal ossification of the distal femoral epiphysis at term, we observed delayed skeletal maturation in 30.1% of term infants with congenital syphilis. We speculate that this delay may be reflective of systemic infection.