Management of infants born to pregnant women with reactive syphilis serology – Resource saving from using the current Centers for Disease Control guidelines

Background: 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 to 10-day course of intravenous penicillin G (PG), in infants considered at low risk for congenital syphilis. Methods: 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, Canada, over a two-year period. Data was 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 CAD$ 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 healthcare resources and in hospital costs.