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An audit against current guideline for the management of children born to VDRL+ mothers
  1. ND Ruth,
  2. T Parmar,
  3. N Makwana
  1. Paediatrics, Sandwell and West Birmingham NHS Trust, Birmingham, UK

Abstract

Background and aims Untreated maternal syphilis results in perinatal loss/morbidity. Congenital infection results in deafness, bone, teeth and eye abnormalities. Children have serology at birth (maternal pairing) and are followed up at intervals until all serology is negative.

Hypothesis Better clinic compliance and reduced follow up duration may be achieved by discharging children once VDRL negative and TPPA titres are decreasing, without adversely affecting outcome.

Methods Retrospective case note audit. 67 cases over a 2 year period (January 2009-January 2011). Criteria assessed included demographics, gestation at booking/referral/delivery, serology, clinic attendance, treatment and mean length of follow-up.

Results 82% of mothers were aged 16-35 years. 67% of patients were Asian/Afro-Caribbean. Co-infection present in 15%, Chlamydia most prevalent. Treatment required at birth in 3%. 20% defaulted clinic follow-up (risk factors: maternal late booker, drug abuse and antenatal clinic defaulter). At birth 75% babies were VDRL negative, and 30% were TPPA negative. Of the 25% of babies found to be VDRL positive at birth (n=9), 90% were negative by 3 months (n=8). 27% of total patients (n=18) were still being seen at 6 months as not all TPPA titres had fallen to zero, however all had reduced. No child with a negative VDRL and falling TPPA titre subsequently required treatment.

Conclusions Based on the information available, a reduced number of appointments, dependent on results of investigations, could be incorporated into future guidelines, therefore reducing costs and potentially improving clinic attendance.

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