Thursday, November 30, 2023
| Patient characteristics | Congenital syphilis, no. (%) | No congenital syphilis, no. (%) | p value | Crude odds ratio (95% CI) | Adjusted odds ratio (95% CI) |
|---|---|---|---|---|---|
| Total | 367 | 238,227 | |||
| Age group, d | |||||
| 0–3 | 340 (92.6) | 233,528 (98.0) | <0.001 | Referent | Referent |
| 4–365 | 27 (7.4) | 4,699 (2.0) | 3.947 (2.60–5.73) | 3.82 (2.52–5.55) | |
| Sex† | Referent | Referent | |||
| F | 179 (49.0) | 116,615 (49.0) | 0.981 | 1.003 (0.82–1.23) | 1.01 (0.82–1.24) |
| M | 186 (51.0) | 121,483 (51.0) | Referent | Referent | |
| Race | |||||
| African American | 261 (71.1) | 103,102 (43.3) | <0.001 | 2.83 (1.72–5.07) | 2.26 (1.37–4.06) |
| White | 92 (25.1) | 119,502 (50.2) | 0.86 (0.51–1.58) | 1.01 (0.60–1.86) | |
| Other | 14 (3.8) | 15,623 (6.5) | Referent | Referent | |
| Residence | |||||
| Nonurban | 213 (58.0) | 133,829 (56.2) | 0.472 | 1.08 (0.88–1.33) | 1.02 (0.83–1.26) |
| Urban | 154 (42.0) | 104,398 (43.8) | Referent | Referent | |
| Primary expected payer | |||||
| Medicaid | 340 (92.6) | 152,221 (63.9) | <0.001 | 7.11 (4.91–10.78) | 5.24 (3.58–8.00) |
| Private/other | 27 (7.4) | 86,006 (36.1) | Referent | Referent | |
Table 1. Demographic characteristics of infants hospitalized with and without congenital syphilis diagnosis, Mississippi, USA, 2016–2022
| Infant characteristics | Congenital syphilis, no. (%) | No congenital syphilis, no. (%) | p value | Crude odds ratio (95% CI) | Adjusted odds ratio (95% CI)* |
|---|---|---|---|---|---|
| Maternal substance use | 340 | 233,529 | <0.001 | ||
| Y | 73 (21.5) | 5,597 (2.4) | 11.14 (8.53–14.36) | 9.39 (7.16–12.16) | |
| N | 267 (78.5) | 227,932 (97.6) | Referent | Referent | |
| Birthweight† | |||||
| Very low birthweight | 28 (8.5) | 4,430 (1.9) | <0.001 | 5.38 (3.55–7.81) | 4.05 (2.67–5.90) |
| Low birthweight | 59 (17.9) | 22,556 (9.7) | 2.23 (1.66–2.94) | 1.81 (1.35–2.40) | |
| Normal birthweight | 242 (73.6) | 205,901 (88.3) | Referent | Referent | |
| Preterm | |||||
| Y | 92 (27.1) | 29,544 (12.7) | <0.001 | 2.56 (2.01–3.24) | 2.26 (1.77–2.86) |
| N | 248 (72.9) | 203,985 (87.3) | Referent | Referent | |
| Newborn respiratory distress | |||||
| Y | 72 (21.2) | 21,204 (9.1) | <0.001 | 2.69 (2.06–3.47) | 2.54 (1.94–3.28) |
| N | 268 (78.8) | 212,325 (90.9) | Referent | Referent | |
Table 2. Delivery subcohort: clinical characteristic for infants with and without congenital syphilis, Mississippi, USA, 2016–2022
*Each of the models was adjusted for demographic characteristics, including race, sex, residence, and payer. We excluded newborns of undetermined/unknown sex from this analysis.
†Not all newborn records had recorded birthweight; therefore, we excluded newborns with unknown birthweight from this analysis (11 records for the congenital syphilis cohort and 642 records for the cohort without congenital syphilis). Very low birthweight, <1,500 g; low birthweight, 1,500-2,500 g; normal birthweight, >2,500 g.
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This activity is intended for primary care clinicians, infectious disease specialists, obstetrician-gynecologists, pediatricians, and other healthcare professionals who treat and manage children at risk for congenital syphilis.
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In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.
Congenital syphilis (CS), caused by infection with the bacterium Treponema pallidum, is a severe disease with potential for immediate and long-term health complications. Infection in pregnant mothers can lead to serious neonatal conditions, such as deformities, hepatosplenomegaly, anemia, jaundice, and failure to thrive[1]. Even though syphilis can be asymptomatic in infants at birth, later sequalae, such as neurologic disorders, occur in ≈40% of untreated children[2]. In addition, syphilis has been associated with severe pregnancy outcomes, including spontaneous abortion, preterm delivery, stillbirth, and infant death[3].
According to Centers for Disease Control and Prevention surveillance data, the nationwide rate of CS increased by 30.5% in 1 year, from 59.7/100,000 live births in 2020 to 77.9/100,000 live births in 2021[4]. In some states, CS rates increased even more dramatically. In Mississippi, for example, CS incidence rose from 104.3/100,000 live births in 2020 to 182.0/100,000 live births in 2021, a 74.5% jump in a single year. For this study, we examined trends, demographics, risk factors, coexisting conditions, and outcomes among infants in Mississippi hospitalized with a CS diagnosis. We aimed to better understand this emerging public health crisis in a state that continues to experience deep social and health inequities.
