Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands.
Centre for International Child Health, University of Melbourne, Parkville, 3052, Australia.
J Trop Pediatr. 2020 Dec 1;66(6):583-588. doi: 10.1093/tropej/fmaa017.
Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis.
All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated.
Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy.
In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.
在一些低收入和中等收入国家，先天性梅毒仍然是导致新生儿死亡和长期神经发育问题的一个重要原因。本研究在所罗门群岛的霍尼亚拉进行，旨在确定患有阳性性病研究实验室（VDRL）检测和阳性梅毒螺旋体血凝试验（TPHA）的母亲所生婴儿的发病率；确定新生儿的 VDRL 状态和先天性梅毒的特征；并估计与梅毒相关的死产比例。
所有 VDRL 阳性母亲所生的新生儿，包括死产儿，均于 2019 年 4 月至 7 月期间纳入研究。对新生儿进行检查、调查和治疗。
在 1534 例连续分娩中，1469 例为活产，65 例（4.2%）为死产。143 例新生儿为 VDRL 阳性母亲所生：130 例（90.1%）为活产婴儿，13 例（8.9%）为死产。在 130 例 VDRL 暴露的活产婴儿中，72 例（55%）VDRL 反应阳性且 TPHA 阳性，7 例（9.7%）有先天性梅毒的临床体征。5 例有感染梅毒临床体征的婴儿的 VDRL 滴度比母亲高 4 倍。在 VDRL 阳性母亲所生的 4 名死亡婴儿中，均有梅毒感染的临床体征。90%受影响的婴儿的母亲在怀孕期间未接受治疗或仅部分接受治疗。
在本研究中，1:210 例活产婴儿有先天性梅毒的临床和血清学证据，并且在死产儿中发现了不成比例的梅毒感染证据。在梅毒感染常见的环境中，可能需要采取经验性预防措施。
