Evaluation (in Addition to Physical Examination and Quantitative Nontreponemal Testing)
Proven or highly probable diseaseb
CSF analysis for VDRL, cell count, and protein
Aqueous crystalline penicillin G, 100 000-150 000 U/kg/day, administered as 50 000 U/kg/dose, IV, every 12 h during the ?rst 7 days of age and every 8 h thereafter for a total of 10 days
CBC and platelet count
Other tests as clinically indicated (eg, long-bone radiography, liver function tests, ophthalmologic examination)
Penicillin G procaine,c 50 000 U/kg/day, IM, in a single dose for 10 days
Normal physical examination and serum quantitative nontreponemal titer the same or less than fourfold the maternal titer:
(a) (i) Mother was not treated or inadequately treated or has no documented Treatment; (ii) mother was treated with erythromycin or other nonpenicillin regimen; (iii) mother received Treatment 4 wk or less before delivery; (iv) maternal evidence of reinfection or relapse (fourfold or greater increase in titers)
CSF analysis for VDRL, cell count, and proteind
Aqueous crystalline penicillin G, IV, for 10 daysd
CBC and platelet countd
Penicillin G procaine,c 50 000 U/kg, IM, in a single dose for 10 daysd
Penicillin G benzathine,c 50 000 U/kg, IM, in a single dosed
(b) (i) Adequate maternal therapy given more than 4 wk before delivery; (ii) mother has no evidence of reinfection or relapse
Clinical, serologic follow-up, and penicillin G benzathine, 50 000 U/kg, IM, in a single dosee
(c) Adequate therapy before pregnancy and mother’s nontreponemal serologic titer remained low and stable during pregnancy and at delivery
CSF indicates cerebrospinal fluid; VDRL, Venereal Disease Research Laboratory; CBC, complete blood cell; IV, intravenously; IM, intramuscularly.
a. If more than 1 day of therapy is missed, the entire course should be restarted.
b. Abnormal physical examination, serum quantitative nontreponemal titer that is fourfold greater than the mother's titer, or positive result of darkfield or fluorescent antibody test of body fluid(s).
c. Penicillin G benzathine and penicillin G procaine are approved for IM administration only.
d. A complete evaluation (CSF analysis, bone radiography, CBC) is not necessary if 10 days of parenteral therapy is administered but may be useful to support a diagnosis of congenital syphilis. If a single dose of penicillin G benzathine is used, then the infant must be evaluated fully, results of the full evaluation must be normal, and follow-up must be certain. If any part of the infant's evaluation is abnormal or not performed or if the CSF analysis is uninterpretable, the 10-day course of penicillin is required.
e. Some experts would not treat the infant but would provide close serologic follow-up.
f. Some experts would treat with penicillin G benzathine, 50 000 U/kg, as a single IM injection, if follow-up is uncertain.
Table 3.75. Recommended Management of Neonates (1 Month of Age or Younger) Born to Mothers With Reactive Serologic Tests for Syphilis is a sample topic found in
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