Neonatal Outcomes of Mothers with Syphilis During Pregnancy: A Retrospective Single Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Laboratory Evaluation
- -
- VDRL test
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- TPHA test
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- Complete blood count
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- Liver function
- -
- -
- Imaging: abdominal ultrasound, brain ultrasound or magnetic resonance imaging, full body X-ray. Cranial ultrasonography (CUS) was performed by experienced neonatologists, as for routine clinical care.
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- Fundus oculi examination
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- Clinical signs and symptoms, including skin rash, hepatosplenomegaly, cholestatic jaundice.
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- Symptoms suggestive of CS;
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- Titer of the neonatal non-treponemal test was fourfold higher than the maternal test at the time of delivery;
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- Persistent positivity of serology after 12 months of life.
2.2. Statistical Analyses
3. Results
3.1. Maternal Data
3.2. Neonatal Data and Outcomes
3.3. Regression Models
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total | ||
---|---|---|
N = 53 | ||
Age, years | 34.0 (29.0–37.0) | |
Country | Italy | 17 (32.1%) |
Romania | 16 (30.2%) | |
Peru | 3 (5.7%) | |
India | 1 (1.9%) | |
Moldavia | 5 (9.4%) | |
Egypt | 1 (1.9%) | |
Poland | 2 (3.8%) | |
Ukraine | 2 (3.8%) | |
Morocco | 1 (1.9%) | |
Nigeria | 1 (1.9%) | |
Russia | 1 (1.9%) | |
Ecuador | 1 (1.9%) | |
Albania | 1 (1.9%) | |
Brazil | 1 (1.9%) | |
Drug user | 1 (1.9%) | |
Previous pregnancies | 26/51 (51.0%) | |
Previous syphilis | 10/53 (18.9%) | |
Previous treatment | 8/53 (15.1%) | |
VDRL positivity | 33/51 (64.7%) | |
VDRL titer | 8.0 (4.0–32.0) | |
TPHA titer | 2560.0 (1280.0–5120.0) | |
Symptoms | 3/53 (5.7%) | |
Syphilis Therapy during pregnancy | 50/52 (96.2%) | |
Compliance to treatment | 50/52 (96.2%) | |
Adequate treatment | 40/52 (76.9%) | |
Follow Up (FU) time, days | 96.0 (55.0–145.0) | |
VDRL at FU#1 positivity | 18/39 (46.2%) | |
VDRL at FU#1 titer | 1/8.0 (1/4.0–1/32.0) | |
TPHA at FU#1 | 1/1280 (1/640–1/5120) |
Total | ||
---|---|---|
N = 53 | ||
Sex | Male | 23 (43.4%) |
Female | 25 (47.2%) | |
Missing | 5 (9.4%) | |
Dead fetus | 1/53 (1.9%) | |
Prenatal US | 38/42 (90.5%) | |
Gestational age (days) | 273.5 (262.0–281.0) | |
Weight of fetus (g) | 3210.0 (2910.0–3620.0) | |
Small for Gestational Age | 4/43 (9.3%) | |
Weight Z score | 0.1 (−0.7–0.7) | |
Weight Percentile | 56.0 (21.0–77.0) | |
Head circumference | 34.0 (33.0–35.0) | |
Head circumference Z score | −1.3 (−2.3–0.3) | |
Head circumference percentile | 71.0 (32.0–83.0) | |
Neonatal Intensive Care Unit admission | 3/31 (9.7%) | |
Birth-to-serology distance, days | 0.0 (0.0–2.0) | |
Time serology baby | 1.0 (1.0–1.5) | |
VDRL baby positivity | 12/43 (27.9%) | |
VDRL baby titer | 8.0 (8.0–32.0) | |
TPHA baby | 2560.0 (1280.0–5120.0) | |
Lumbar puncture done | 9/53 (17%) | |
CSF Protein pathologic | 4/9 (44.4%) | |
CSF Vdrl positivity | 3/8 (37.5%) | |
Hemoglobin, gr/dL | 17.8 (14.4–19.9) | |
Platelets, N × 109/L | 228.0 (159.0–283.0) | |
Asparatate aminotransferase, U/L | 38.0 (0.0–65.0) | |
Alanin aminotransferase, U/L | 13.0 (8.0–21.0) | |
Brain US positivity | 4/15 (26.7%) | |
Abdominal US positivity | 2/17 (11.8%) | |
CS treatment | 6/43 (14.0%) | |
Baby FU1 distance (days) | 49.0 (12.0–206.0) | |
Baby FU1 Vdrl positive | 2/19 (10.5%) | |
Baby FU1 TPHA titer | 640.0 (160.0–1280.0) | |
Congenital syphilis | 4/53 (7.5%) | |
Probable syphilis | 2/53 (3.8%) |
Total | No CS | CS | p-Value | ||
---|---|---|---|---|---|
N = 53 | N = 49 | N = 4 | |||
Maternal Age | 34.0 (29.0–37.0) | 34.0 (29.0–37.0) | 33.0 (25.5–40.0) | 0.89 | |
Vdrl titer in mother | 8.0 (4.0–32.0) | 8.0 (4.0–32.0) | 16.0 (16.0–16.0) | 0.6 | |
Drug-user | 1 (1.9%) | 1 (2.0%) | 0 (0.0%) | 0.77 | |
Co-infection | 1 (1.9%) | 1 (2.0%) | 0 (0.0%) | 0.77 | |
Previous syphilis | 10 (18.9%) | 8 (16.3%) | 2 (50.0%) | 0.098 | |
Previous treatment | 8 (15.1%) | 8 (16.3%) | 0 (0.0%) | 0.38 | |
TPHA titer in mother | 2560.0 (1280.0–5120.0) | 2560.0 (1280.0–5120.0) | 3200.0 (1280.0–5120.0) | 0.62 | |
Mother Therapy | 50 (96.2%) | 46 (95.8%) | 4 (100.0%) | 0.68 | |
Adequate treatment | 40 (76.9%) | 39 (81.2%) | 1 (25.0%) | 0.01 | |
Delivery type | Vaginal | 37 (69.8%) | 34 (69.4%) | 3 (75.0%) | 0.94 |
Cesarean | 15 (28.3%) | 14 (28.6%) | 1 (25.0%) | ||
Missing | 1 (1.9%) | 1 (2.0%) | 0 (0.0%) | ||
Sex | Male | 23 (43.4%) | 22 (44.9%) | 1 (25.0%) | 0.48 |
Female | 25 (47.2%) | 22 (44.9%) | 3 (75.0%) | ||
Missing | 5 (9.4%) | 5 (10.2%) | 0 (0.0%) | ||
Death of fetus | 1 (1.9%) | 1 (2.0%) | 0 (0.0%) | 0.77 | |
Prenatal US | 38 (90.5%) | 37 (92.5%) | 1 (50.0%) | 0.046 | |
Gestational age, days | 273.5 (262.0–281.0) | 274.5 (267.0–281.0) | 265.0 (227.5–271.0) | 0.064 | |
Weight of fetus, g | 3210.0 (2910.0–3620.0) | 3210.0 (2910.0–3600.0) | 3600.0 (1965.0–4250.0) | 0.71 | |
Head Circumference | 34.0 (33.0–35.0) | 34.0 (33.0–35.0) | 37.0 (23.0–37.0) | 0.33 | |
NICU admission | 3 (5.6%) | 1 (3.4%) | 2 (50.0%) | <0.001 | |
VDRL baby positivity | 12 (27.9%) | 10 (25.6%) | 2 (50.0%) | 0.3 | |
VDRL titer in newborn | 8.0 (8.0–32.0) | 8.0 (4.0–8.0) | 80.0 (32.0–128.0) | 0.076 | |
TPHA baby | 2560.0 (1280.0–5120.0) | 2560.0 (1280.0–5120.0) | 1280.0 (1280.0–3200.0) | 0.55 | |
CSF analysis performed | 9 (22.5%) | 6 (16.7%) | 3 (75.0%) | 0.008 | |
CSF VDRL | 0.0 (0.0–1024.0) | 0.0 (0.0–0.0) | 1024.0 (1024.0–1024.0) | 0.031 | |
Hemoglobin, g/dL | 17.8 (14.4–19.9) | 17.8 (14.7–20.0) | 14.4 (8.7–17.8) | 0.24 | |
Platelets, N × 109/L | 228.0 (159.0–283.0) | 255.0 (183.0–286.0) | 126.5 (21.5–225.0) | 0.15 | |
Asparatate aminotransferase, U/L | 38.0 (0.0–65.0) | 37.0 (0.0–64.5) | 232.0 (232.0–232.0) | 0.089 | |
Alanin aminotransferase, U/L | 13.0 (8.0–21.0) | 12.0 (7.0–17.0) | 42.5 (22.0–95.0) | 0.005 | |
Brain US positivity | 4 (26.7%) | 2 (18.2%) | 2 (50.0%) | 0.22 | |
Abdominal US positivity | 2 (11.8%) | 0 (0.0%) | 2 (50.0%) | <0.001 |
Total | No | Congenital + Probable | p-Value | ||
---|---|---|---|---|---|
N = 53 | N = 47 | N = 6 | |||
Maternal Age, years | 34.0 (29.0–37.0) | 34.0 (29.0–37.0) | 34.0 (26.0–40.0) | 0.82 | |
VDRL titer in mother | 8.0 (4.0–32.0) | 8.0 (4.0–32.0) | 16.0 (16.0–16.0) | 0.6 | |
Drug-user | 1 (1.9%) | 1 (2.1%) | 0 (0.0%) | 0.72 | |
Co-infection | 1 (1.9%) | 1 (2.1%) | 0 (0.0%) | 0.72 | |
Previous syphilis | 10 (18.9%) | 8 (17.0%) | 2 (33.3%) | 0.34 | |
Previous treatment | 8 (15.1%) | 8 (17.0%) | 0 (0.0%) | 0.27 | |
Positive partner | 9 (16.9%) | 8 (80.0%) | 1 (100.0%) | 0.62 | |
Tpha titer mother | 2560.0 (1280.0–5120.0) | 2560.0 (640.0–5120.0) | 3840.0 (1280.0–5120.0) | 0.36 | |
Therapy | 50/52 (96.2%) | 44 (93.6%) | 6 (100.0%) | 0.6 | |
Adequate treatment | 40 (76.9%) | 39 (84.8%) | 1 (16.7%) | <0.001 | |
Delivery type | Vaginal | 37 (69.8%) | 32 (68.1%) | 5 (83.3%) | 0.73 |
Cesarean | 15 (28.3%) | 14 (29.8%) | 1 (16.7%) | ||
Missing | 1 (1.9%) | 1 (2.1%) | 0 (0.0%) | ||
Sex | Male | 23 (43.4%) | 22 (46.8%) | 1 (16.7%) | 0.16 |
Female | 25 (47.2%) | 20 (42.6%) | 5 (83.3%) | ||
Missing | 5 (9.4%) | 5 (10.6%) | 0 (0.0%) | ||
Death of fetus | 1 (1.9%) | 1 (2.1%) | 0 (0.0%) | 0.72 | |
Prenatal US | 38 (90.5%) | 36 (94.7%) | 2 (50.0%) | 0.004 | |
Gestational age, days | 273.5 (262.0–281.0) | 275.5 (267.5–281.0) | 264.5 (244.0–271.0) | 0.015 | |
Weight of fetus, g | 3210.0 (2910.0–3620.0) | 3210.0 (2915.0–3600.0) | 3162.5 (2520.0–4250.0) | 0.94 | |
Small for Gestational Age | 4 (7.5%) | 3 (6.4%) | 1 (16.0%) | 0.5 | |
Weight Z score | 0.1 (−0.7–0.7) | 0.1 (−1.0–0.9) | 0.0 (−0.7–0.7) | 0.94 | |
Weight percentile | 56.0 (21.0–77.0) | 56.0 (16.0–74.5) | 51.0 (25.0–77.0) | 0.89 | |
Head Circumference | 34.0 (33.0–35.0) | 34.0 (33.0–35.0) | 34.0 (32.0–37.0) | 0.87 | |
Head Circumference centile | 71.0 (32.0–83.0) | 71.0 (33.3–87.5) | 53.0 (32.0–74.0) | 0.67 | |
NICU adm | 3 (5.6%) | 1 (2.1%) | 2 (33.3%) | 0.003 | |
VDRL in newborn positivity | 12 (22.6%) | 10 (21.2%) | 2 (33.3%) | 0.75 | |
VDRL titer in newborn | 8.0 (8.0–32.0) | 8.0 (4.0–8.0) | 80.0 (32.0–128.0) | 0.076 | |
TPHA titer in newborn | 2560.0 (1280.0–5120.0) | 2560.0 (1280.0–5120.0) | 1920.0 (1280.0–2560.0) | 0.67 | |
CSF analysis performed | 9 (22.5%) | 5 (14.7%) | 4 (66.7%) | 0.005 | |
VDRL in CSF | 0.0 (0.0–1024.0) | 0.0 (0.0–0.5) | 1024.0 (0.0–1024.0) | 0.17 | |
Hemoglobin, g/dL | 17.8 (14.4–19.9) | 17.7 (14.7–19.4) | 17.8 (11.1–19.9) | 0.96 | |
Platelets, N × 109/L | 228.0 (159.0–283.0) | 260.0 (159.0–286.0) | 223.5 (28.0–225.0) | 0.21 | |
Asparatate aminotransferase, U/L | 38.0 (0.0–65.0) | 36.0 (0.0–65.0) | 141.0 (50.0–232.0) | 0.14 | |
Alanin aminotransferase, U/L | 13.0 (8.0–21.0) | 11.5 (3.5–17.5) | 22.0 (17.0–63.0) | 0.013 | |
Brain US positivity | 4 (7.5%) | 1 (2.1%) | 3 (50.0%) | 0.095 | |
X ray | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
Abdominal us positivity | 2 (3.8%) | 0 (0.0%) | 2 (33.3%) | 0.001 |
Total | Inadequate | Adequate | p-Value | ||
---|---|---|---|---|---|
N = 52 | N = 12 | N = 40 | |||
Maternal Age | 34.0 (29.0–37.0) | 35.0 (31.5–38.0) | 33.5 (28.5–37.0) | 0.29 | |
Baseline VDRL in mother | 8.0 (4.0–32.0) | 16.0 (16.0–16.0) | 8.0 (4.0–32.0) | 0.6 | |
Drug use | 1 (1.9%) | 0 (0.0%) | 1 (2.5%) | 0.58 | |
Coinfection | 1 (1.9%) | 0 (0.0%) | 1 (2.5%) | 0.58 | |
Previous syphilis | 10 (19.2%) | 1 (8.3%) | 9 (22.5%) | 0.27 | |
Previous treatment | 8 (15.4%) | 0 (0.0%) | 8 (20.0%) | 0.092 | |
Positive partner | 9 (17.3%) | 3 (25.0%) | 6 (15.0%) | 0.34 | |
Baseline TPHA mother | 2560.0 (1280.0–5120.0) | 5120.0 (1920.0–5120.0) | 1920.0 (1280.0–5120.0) | 0.2 | |
Delivery type | Vaginal | 36 (69.2%) | 6 (50.0%) | 30 (75.0%) | 0.17 |
Cesarean | 15 (28.8%) | 6 (50.0%) | 9 (22.5%) | ||
Missing | 1 (1.9%) | 0 (0.0%) | 1 (2.5%) | ||
Sex | Male | 23 (44.2%) | 5 (41.7%) | 18 (45.0%) | 0.36 |
Female | 24 (46.2%) | 7 (58.3%) | 17 (42.5%) | ||
Missing | 5 (9.6%) | 0 (0.0%) | 5 (12.5%) | ||
Congenital Syphlis | 4 (7.7%) | 3 (25%) | 2 (2.5%) | 0.01 | |
Probable Congenital Syphlis | 2 (3.8%) | 2 (16.7%) | 0 | 0.008 | |
Death of fetus | 1 (1.9%) | 0 (0.0%) | 1 (2.5%) | 0.58 | |
Prenatal US | 37 (71.2%) | 7 (58.3%) | 30 (75.0%) | 0.013 | |
Gestational age (days) | 274.0 (267.0–281.0) | 260.5 (246.0–272.5) | 278.0 (271.0–282.0) | 0.003 | |
Weight of fetus, g | 3227.5 (2915.0–3620.0) | 2950.0 (2255.0–3375.0) | 3310.0 (2925.0–3700.0) | 0.067 | |
Small for Gestational Age | 2 (3.8%) | 1 (8.3%) | 1 (2.5%) | 0.02 | |
Weight Z score | 0.2 (−0.7–0.8) | 0.5 (−0.2–1.1) | −0.0 (−1.0–0.7) | 0.43 | |
Percentile | 56.0 (21.0–77.0) | 62.0 (25.0–77.0) | 54.0 (21.0–67.0) | 0.84 | |
Head circumference | 34.0 (33.0–35.0) | 33.0 (31.1–35.0) | 34.0 (34.0–35.0) | 0.17 | |
NICU admission | 3 (5.7%) | 2 (8.3%) | 1 (2.5%) | 0.061 | |
VDRL positivity in newborn | 12 (28.6%) | 5 (41.7%) | 7 (23.3%) | 0.23 | |
VDRL titer in newborn | 1/8.0 (1/8.0–1/32.0) | 1/32.0 (1/4.0–1/128.0) | 1/8.0 (1/8.0–1/8.0) | 0.55 | |
Baseline TPHA level in newborn | 2560.0 (1280.0–5120.0) | 2560.0 (1280.0–12,800.0) | 2560.0 (1280.0–5120.0) | 0.45 | |
CSF analysis performed | 9 (23.1%) | 7 (63.6%) | 2 (7.1%) | <0.001 | |
VDRL CSF | 0.0 (0.0–1/1024.0) | 0.0 (0.0–0.0) | 1/512.5 (1.0–1/1024.0) | 0.13 | |
Hemoglobin, g/dL | 17.8 (14.7–19.9) | 17.5 (13.3–17.8) | 17.9 (15.2–20.2) | 0.28 | |
Platelets, N × 109/L | 235.0 (171.0–284.5) | 226.5 (209.0–255.0) | 271.5 (159.0–327.0) | 0.37 | |
Asparatate aminotransferase, U/L | 37.0 (0.0–64.5) | 50.0 (36.0–232.0) | 34.0 (0.0–64.0) | 0.21 | |
Alanin aminotransferase, U/L | 13.0 (8.0–21.0) | 17.5 (12.0–27.0) | 11.0 (0.0–19.0) | 0.039 | |
Brain US positivity | 4 (28.6%) | 2 (25.0%) | 2 (33.3%) | 0.73 | |
Abdominal US positivity | 2 (12.5%) | 2 (40.0%) | 0 (0.0%) | 0.025 |
Sex | Birth Weight (g) | GA | Maternal Origin | Prenatal Care | Maternal Treatment | CS Diagnosis: Serologic Tests and Others Investigations | CS diagnosis: Clinical Features | Long Bone X-Ray | CSF | Outcome |
---|---|---|---|---|---|---|---|---|---|---|
M | 2950 | 37 | Peru | no | Post partum | VDRL 1/32 TPHA 1/1280 Low Hb Low PLTs Hepatitis | Rash Hepatosplenomegaly | Normal | Normal | Cured (IV penicillin) |
F | 980 | 28 | Romania | no | Post partum | VDRL 1/128 TPHA 1/5120 Low PLTs Hepatitis | Ascites Hepatosplenomegaly Ventricolomegaly | Normal | Normal | Cured (IV penicillin) |
F | 4250 | 38 | Moldavia | yes | Non adequate | VDRL neg TPHA 1/1280 | asymptomatic | Normal | VDRL reactive | Cured (IV penicillin) |
F | 4150 | 39 | Moldavia | no | Non adequate | VDRL neg TPHA 1/1280 | asymptomatic | Normal | VDRL reactive | Cured (IV penicillin) |
F | 2520 | 36 | Romania | no | Post partum | VDRL neg TPHA 1/2560 | asymptomatic | Normal | Normal | Cured (IM penicillin) * |
F | 3375 | 38 | Italy | Yes | Non adequate | VDRL neg TPHA 1/2560 | asymptomatic | Normal | Normal | Cured (IM penicillin) * |
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Buonsenso, D.; Raffaelli, F.; Camporesi, A.; Fiori, B.; Ricci, R.; Romano, L.; De Santis, M.; Vento, G.; Torti, C.; Tamburrini, E.; et al. Neonatal Outcomes of Mothers with Syphilis During Pregnancy: A Retrospective Single Center Experience. Children 2025, 12, 307. https://doi.org/10.3390/children12030307
Buonsenso D, Raffaelli F, Camporesi A, Fiori B, Ricci R, Romano L, De Santis M, Vento G, Torti C, Tamburrini E, et al. Neonatal Outcomes of Mothers with Syphilis During Pregnancy: A Retrospective Single Center Experience. Children. 2025; 12(3):307. https://doi.org/10.3390/children12030307
Chicago/Turabian StyleBuonsenso, Danilo, Francesca Raffaelli, Anna Camporesi, Barbara Fiori, Rosalba Ricci, Lucio Romano, Marco De Santis, Giovanni Vento, Carlo Torti, Enrica Tamburrini, and et al. 2025. "Neonatal Outcomes of Mothers with Syphilis During Pregnancy: A Retrospective Single Center Experience" Children 12, no. 3: 307. https://doi.org/10.3390/children12030307
APA StyleBuonsenso, D., Raffaelli, F., Camporesi, A., Fiori, B., Ricci, R., Romano, L., De Santis, M., Vento, G., Torti, C., Tamburrini, E., & Valentini, P. (2025). Neonatal Outcomes of Mothers with Syphilis During Pregnancy: A Retrospective Single Center Experience. Children, 12(3), 307. https://doi.org/10.3390/children12030307