Abstract
BACKGROUND: Congenital syphilis rates are rising in the United States and globally, necessitating standardized care for infants born to mothers with syphilis. The Centers for Disease Control recommends comprehensive evaluation, treatment, and follow-up for these infants to ensure optimal outcomes. LOCAL PROBLEM: At Los Angeles General Medical Center, a retrospective review of 97 infants (2022-2023) revealed gaps in adherence to national guidelines, particularly in risk stratification, treatment decisions, and outpatient follow-up planning. Among 15 syphilis-exposed infants (2 unknown-risk, 4 high-risk, 9 low-risk), some received abbreviated or potentially inadequate treatment without a full evaluation, while others had treatment deferred without ensuring appropriate outpatient follow-up. These inconsistencies in postnatal management highlighted the need for a structured, multidisciplinary approach to improve adherence to best practices. METHODS: A quality improvement team developed the "Congenital Syphilis Pathway" to standardize care and improve adherence to the Centers for Disease Control guidelines. The intervention included recommended Pediatric Infectious Disease consultation to improve risk stratification and treatment decisions, targeted provider education to enhance guideline adherence, and systematic scheduling of outpatient follow-up to ensure appropriate postnatal monitoring. The pathway aimed to achieve 90% compliance with recommended evaluation, treatment, and follow-up practices between January and June 2024. INTERVENTIONS: The pathway recommended a Pediatric Infectious Disease consultation for all eligible infants during their hospital stay and included educational sessions on congenital syphilis management for key stakeholders at three points during implementation to reinforce protocol adherence. RESULTS: The population included all infants born to mothers with syphilis at Los Angeles General Medical Center. Following pathway implementation in January 2024, Pediatric Infectious Disease consultation rates reached 100% by June 2024. Appropriate management improved from 85% at baseline to 100% in Q2 2024, while follow-up scheduling increased from 54% at baseline to 91% in Q2 2024. CONCLUSION: A structured care pathway integrating standardized consultations, provider education, and systematic follow-up planning significantly improved adherence to congenital syphilis management guidelines. While direct pediatric infectious disease consultation may not be feasible in all settings, the core elements of this intervention - standardized evaluation pathways, provider education, and public health collaboration - can be adapted to improve care in diverse health care environments.