(P23) IMPLEMENTATION OF A CONGENITAL SYPHILIS PATHWAY TO IMPROVE QUALITY OF CARE

Tuesday, September 17, 2024

4:15 PM - 5:15 PM EST

Primary Author(s)

Diana D. Villarreal, MD, PhD (she/her/hers)

Pediatric Infectious Disease Fellow
Keck School of Medicine of the University of Southern California
Glendale, California, United States
Jessica Perez (she/her/hers)

Medical Student
Department of Population and Public Health Sciences, University of Southern California
Norwalk, California, United States

Co-Author(s)(s)

Jeffrey D. Klausner, MD (he/him/his)

Clinical Professor
Department of Population and Public Health Sciences, University of Southern California
Los Angeles, California, United States
JH

James Homans, MD

Keck School of Medicine of the University of Southern California
KL

Katherine A. Lewis, MPH

Keck School of Medicine of the University of Southern California
MC

Mikhaela Cielo, MD

Keck School of Medicine of the University of Southern California

Background:
Syphilis has reached its highest levels since the 1950s. The evaluation and management of infants born to mothers with syphilis is based on risk stratification, as there is no biomarker of infection in a neonate. Neonatal serologies reflect the mixed immune status of the mother and the child and are rarely useful. Infant evaluation and treatment decisions are based on maternal infection and treatment history.

Methods:
With high numbers of infants born to mothers with a history of syphilis, we have implemented a comprehensive clinical pathway. We performed a chart review to identify opportunities for improvement. Next, we began a collaboration and referral pathway with the Los Angeles County Department of Public Health. We then disseminated a clear 1-page “Congenital Syphilis Pathway” with visual diagram to the pediatric resident workroom. In this pathway, we recommended pediatric infectious disease consultation for each infant, discussion of maternal syphilis history with the department of public health STI nurses, and outpatient follow-up for the infant to repeat RPR. When appropriate, pediatric infectious disease consultation includes referral of the mother to supportive services including the Addiction Medicine service and our nurse clinical navigator for education and discussion of HIV PrEP.

Results:
Our major outcomes include appropriate evaluation and treatment of each infant, percentage of infants with pediatric infectious disease consultation, percentage of eligible mothers that were referred to supportive services, and percentage of infants with outpatient follow-up of development and repeat RPR.

Conclusion:
While public health focuses on the adequate treatment in pregnancy to prevent congenital syphilis, the pediatrician and pediatric infectious disease physician focus on the proper evaluation, management, and follow-up of the infants born to mothers with a history of syphilis. As this quality improvement project develops from October 2023 through October 2024, we hope to see sustained improvement in all of the aforementioned outcomes.