Follow-up of infants with congenital syphilis during the penicillin shortage period

Rocha, Ana Fátima Braga; Araújo, Maria Alix Leite; Oliveira, Ana Karinne Dantas de; Oliveira, Lucas Fernandes de; Pimentel, Lea Dias Gomes Vasconcelos; Melo, Adriana Lopes Lima

doi:10.1016/j.jped.2022.11.011

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Sumário

Original article • J. Pediatr. (Rio J.) 99 (3) • May-Jun 2023 • https://doi.org/10.1016/j.jped.2022.11.011 copy

Follow-up of infants with congenital syphilis during the penicillin shortage period^☆ ☆ Institution where the study was carried out: Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage.

Method

A cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments.

Results

A total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20-6.22; p< 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57-6.87; p= 0.002). Only 33.7% (34/101) were followed until discharge.

Conclusion

The majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.

Keywords
Syphilis; Congenital; Signs and symptoms; Lost to follow-up

Variables	n	%
Attended the appointment (n= 469)
Yes	101	21.5
No	368	78.5
Location of the follow-up outpatient clinic (n= 101)
At the maternity hospital where the child was born	79	78.2
In another service	22	21.8
Age at the 1st appointment (n= 101)
1 month	71	70.3
≥2 months	30	29.7
Number of VDRL tests (n= 101)
None	28	27.7
1	35	34.6
≥2	38	37.7
Age in months when the 1st VDRL test was performed (n= 73)
1	43	58.9
3	21	28.8
6	6	8.2
12	2	2.7
18	1	1.4
Age when the VDRL test was negative (n= 49)
≤6	44	89.8
>6	5	10.2
Had any clinical manifestations of CS (n= 101)
Yes	16	15.8
No/Ignored	85	84.2
Type of clinical manifestation of CS (n= 16)^a a Some infants showed more than one alteration during the follow-up.
Anemia	9	56.3
Hepatic	2	12.5
Cardiocirculatory	1	6.3
Dermatological	3	18.8
Respiratory	1	6.3
Neurological	3	18.8
Was discharged from follow-up (n= 101)
Yes	34	33.7
No	67	66.3

Variables	Child attended the follow-up appointments				p-value
	Yes		No
	n	%	n	%
Mother's age (n= 469)					0.245
≤18 years	19	26.8	52	73.2
≥19 years	82	20.6	316	79.4
Marital status (n= 469)					0.150
No partner	38	18.4	168	81.6
With partner	63	24.0	200	76.0
Level of schooling, years (n= 469)					0.887
≤8 years	71	21.7	256	78.3
≥9 years	30	21.1	112	78.9
Paid work (n= 469)					0.815
Yes	26	20.8	99	79.2
No	75	21.8	269	78.2
Use of illicit drugs (n= 469)					0.001
Yes	9	9.1	90	90.9
No	92	24.9	278	75.1
Attended prenatal appointments (n= 469)					0.035
Yes	91	23.3	299	76.7
No	10	12.7	69	87.3
Number of prenatal appointments (n= 390)					0.023
<6	33	18.1	149	81.9
≥6	58	27.9	150	72.1
Moment of maternal diagnosis (n= 469)					0.003
Prenatal	70	26.5	194	73.5
Delivery	31	15.1	174	84.9
Treatment of the pregnant woman during prenatal care (n= 264)					0.176
With benzathine penicilline	52	29.1	127	70.9
Another medication/Not performed	18	21.2	67	78.8
VDRL test result at birth (n= 467)					0.141
Reactive	74	20.2	293	79.8
Non-reactive	27	27.0	73	73.0
VDRL titration at birth (n= 367)					0.916
<1:8	55	20.3	216	79.7
≥1:8	19	19.8	77	80.2
Newborn with symptoms at birth (n= 456)					0.185
Yes	37	18.6	162	81.4
No	61	23.7	196	76.3
Prematurity (n= 469)					0.009
Yes	6	9.2	59	90.8
No	95	23.5	309	76.5
Low birth weight (n= 469)					0.012
Yes	10	11.5	77	88.5
No	91	23.8	291	76.2
Treatment at birth (n= 469)					0.745
Standard treatmentb	44	20.9	167	79.1
Another treatment	57	22.1	201	77.9
Location of follow-up outpatient clinic (n= 101)					<0.001
At the maternity hospital where birth occurred	79	30.4	181	69.6
In another service	22	10.5	187	89.5

Variables			Non-attendance to follow-up
			Non-adjusted			Adjusted
	n	%	OR	(95%CI)	p-value	OR	(95%CI)	p-value
Mother without steady partner (n= 469)	168	81.6	1.3	(0.86-2.25)	0.150	-	-	-
Use of illicit drugs (n= 469)	90	90.9	3.3	(1.57-7.75)	0.001	3.2	(1.57-6.87)	0.002
Did not attend prenatal care (n= 469)	69	87.3	2.1	(1.02-4.75)	0.035	-	-	-
Fewer than 6 prenatal appointments (n= 390)	149	81.9	1.7	(1.04-2.92)	0.023	-	-	-
Mother's diagnosis at delivery (n= 469)	174	84.9	2.0	(1.23-3.35)	0.003	-	-	-
Not treated with penicillin or no prenatal treatment (n= 264)	67	78.8	1.5	(0.79-2.99)	0.176	-	-	-
Reactive VDRL test result at birth (n= 467)	293	79.8	1.4	(0.84-2.49)	0.141	-	-	-
Newborn with symptoms at birth (n= 456)	162	81.4	1.3	(0.84-2.22)	0.185	-	-	-
Prematurity (n= 469)	59	90.8	3.0	(1.25-8.82)	0.009	-	-	-
Low birth weight (n= 469)	77	88.5	2.4	(1.17-5.43)	0.012	-	-	-
Outpatient clinic in a different place than the maternity hospital (n= 469)	181	69.6	3.7	(2.17-6.51)	<0.001	3.7	(2.20-6.22)	<0.001

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E-mail: jped@jped.com.br

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[1] ⁎ Corresponding author. E-mail: karinnedantas1@gmail.com (A.K. de Oliveira).

Brasil

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Follow-up of infants with congenital syphilis during the penicillin shortage period☆ ☆ Institution where the study was carried out: Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.

Abstract

Objective

Method

Results

Conclusion

Follow-up of infants with congenital syphilis during the penicillin shortage period^☆ ☆ Institution where the study was carried out: Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.