title: Missed opportunities for preventing congenital syphilis infection in New York City.
abstract: OBJECTIVE
  To describe health care providers' missed opportunities for preventing and treating congenital syphilis in New York City.
  
  
  METHODS
  Review of congenital syphilis cases reported to the New York City Department of Health and Mental Hygiene from January 1, 2000 to December 31, 2009. Receipt and timing of prenatal care, serologic testing, and treatment of mothers and newborns were reviewed. Missed opportunities were defined as receipt of prenatal care plus one of the following: 1) lack of documented treatment for syphilis infection diagnosed before pregnancy; 2) absence of serologic testing during pregnancy; 3) late maternal treatment; 4) maternal treatment with a nonpenicillin regimen; or 5) lack of maternal treatment.
  
  
  RESULTS
  In total, 195 newborns with congenital syphilis were born to 190 mothers with 191 pregnancies. Overall, 80% (95% confidence interval [CI] 74-86%, 152 of 190) of all mothers received prenatal care; 63% (95% CI 56-71%, 96 of 152) of these had one or more missed opportunities for prevention. Twelve mothers received inadequate treatment or no treatment during the case pregnancy for documented syphilis infection before pregnancy, and 42 mothers without previous syphilis diagnosis did not have serologic testing during the case pregnancy. Of 103 mothers with syphilis diagnosed before 30 weeks of gestation, 12 received late penicillin therapy, 27 received no therapy, and 3 received inappropriate (nonpenicillin) therapy. Seventeen percent (95% CI 12-22%, 33 of 193) of liveborn newborns received no treatment during their hospitalization.
  
  
  CONCLUSIONS
  Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians.
  
  
  METHODS
  III.
authors.affiliation: Department of Pediatrics, Columbia University, and the Bureau of Sexually Transmitted Diseases Control, New York City Department of Health and Mental Hygiene, New York, New York 10032, USA. sp2172@columbia.edu
authors.forename: Sameer J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Klinger
authors.forename: Dana
authors.initials: D
authors.lastname: OʼToole
authors.forename: Julia A
authors.initials: JA
authors.lastname: Schillinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010406:Penicillins / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis / Q000188:drug therapy; D013588:Syphilis Serodiagnosis; D013590:Syphilis, Congenital / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins