ABSTRACT
OBJECTIVE
Congenital syphilis (CS) has reemerged as a critical public health concern in the United States, with rates increasing 10-fold over the past decade. Rising CS cases pose clinical challenges for hospital-based pediatricians, including newborn nursery hospitalists and neonatologists, who are often central to diagnosis, treatment, and follow-up. This study examines patient- and hospital-level characteristics, risk factors, and neonatal outcomes among infants born with CS.
METHODS
A retrospective cohort study of 6.75 million patients (2019–2024) was conducted using the Vizient Clinical Data Base. Patients with CS (n = 6583) were identified using International Classification of Diseases, Tenth Revision codes, and a delivery subcohort was analyzed. Multivariable regressions assessed associations between demographic factors, neonatal outcomes, and the Vizient Vulnerability Index (VVI), a composite measure of social determinants of health from community-level indicators.
RESULTS
CS cases more than doubled from 2019 to 2024, increasing in prevalence from 0.05% to 0.13% among index inpatient encounters of children aged 0 to 24 months. Patients with CS were more likely to experience adverse outcomes not directly caused by infection, including being affected by neonatal withdrawal syndrome and extreme prematurity. Black race, Medicaid payer, and high vulnerability was strongly associated with CS. Newborn patients with CS had longer hospital length of stays (11 [10–15] vs 2 [2–3] days), higher intensive care unit admission (53.0% vs 9.3%), and greater in-hospital mortality (0.7% vs 0.4%) compared with those without CS.
CONCLUSION
Public awareness and universal screening policies have not slowed the rising CS prevalence. Using tools such as the VVI may enable targeted screening and therapy to improve CS prevention and outcome.