(P8) THE UTILITY OF CEREBROSPINAL FLUID INDICES IN THE EVALUATION OF NEONATES EXPOSED TO SYPHILIS IN UTERO

Tuesday, September 17, 2024

4:15 PM - 5:15 PM EST

Primary Author(s)

Rosalyn Plotzker, MD, MPH (she/her/hers)

Medical Officer
California Department of Public Health
San Francisco, California, United States

Co-Author(s)(s)

EM

Ellen McCleery, MD

Confluence Health Hospital Central Campus
Elizabeth Partridge, MD, MPH (she/her/hers)

Associate Clinical Professor
University California, Davis Children's Hospital
Sacramento, California, United States

Background:
Syphilis is re-emerging, with recent increases in congenital infections. Infants who meet criteria for congenital syphilis (CS) Scenarios 1 and 2 are indicated for cerebrospinal fluid (CSF) evaluation, complete blood count (CBC) and long bone radiograph. While CSF can inform management, specimen collection requires technical skill and interpretations of the three indices implicated - protein, nontreponemal testing, and pleocytosis - are nuanced.

Methods:
We performed chart reviews of infants <30 days old born to birthing parents with syphilis infection, who were delivered between January 2000 and October 2020. Syphilis evaluation and treatment information for birthing parents and infants were abstracted. Infants were categorized per the Centers for Disease Control and Prevention CS scenarios. CSF indices as well as other evaluation test results were described by scenario.

Results:
109 infants met inclusion criteria: 8 (7.3%), 66 (60.6%), 31 (28.4%), and 4 (3.7%) met criteria for Scenarios 1, 2, 3, and 4, respectively. The overall lumbar puncture (LP) success rate was 59.7%. Among Scenario 2 infants, 45.2% received 10 days of intravenous therapy due to an unsuccessful CSF evaluation. LP results were successful for 5 (62.5%) Scenario 1 infants, and 37 (56.1%) Scenario 2 infants. All Scenario 1 LP results had one or more CSF abnormality, compared with 35.1% for Scenario 2 (p = .0009). All infants with an abnormal CSF result – Scenarios 1 and 2 combined – had elevated protein; 72.2% of these additionally had either an abnormal nontreponemal test, pleocytosis, or both. Finally, 30 Scenario 2 infants with successful LPs had CBC and long bone X-rays documented; 5 were indicated for intravenous therapy according to a non-CSF finding, 4 of whom had a normal CSF.

Conclusion:
Improving LP skill, prioritizing protein when CSF volume is low, and using a stepwise approach starting with less invasive tests may optimize the neonatal syphilis evaluation.