Evolução clínica das crianças expostas à sífilis intra-útero em um hospital universitário

Abstract

Objective: To describe the sociodemographic characteristics of parturients with gestational syphilis in a university hospital, to evaluate maternal treatment, clinical evolution and outpatient follow-up of children exposed to this infection. Methodology: Retrospective cohort carried out through the analysis of medical records of children exposed to syphilis, born at the Hospital de Clínicas of the Federal University of Uberlândia, from 2015 to 2018. A questionnaire was developed to assess maternal sociodemographic variables, life habits, number of prenatal consultations, diagnosis and treatment of maternal syphilis, data on the moment of delivery, characteristics of newborns (NB), treatment and outpatient follow-up. Mothers were divided into 2 groups according to treatment: adequate and inadequate or absent. The newborns were also divided into 2 groups according to the diagnosis: exposed to syphilis and congenital syphilis (CS). Results: An increase in the prevalence of gestational syphilis was observed, in addition to a greater number of cases of CS (66%) in the population studied. The absence of addictions and early diagnosis of the infection during pregnancy were associated with greater chances of adequate maternal treatment (OR: 3.121; CI: 1.718-5.671) and the NB being exposed to syphilis (OR: 3.704; CI: 1.971-6.959). NB with CS had lower weight (2874.32 ± 846.49 x 3096.33 ± 502.25) and head circunference (32.75 ± 3.15 x 33.92 ± 1.51) at birth, lower Apgar scores 1st (7.55 ± 1.85 x 8.04 ± 1.06) and 5th minutes (8.68 ± 1.46 x 8.9 ± 0.58) and longer hospital stays (11 versus 3). Regarding outpatient follow-up, no differences were seen in the number of consultations, age at which the VDRL was negative, and specialized workup, according to the child's diagnosis. Conclusion: There was an increase in the prevalence of gestational syphilis during the study period, especially in the group of mothers with inadequate or absent treatment. At the same time, there was an increase in the incidence of SC. The late diagnosis of the infection during pregnancy and the presence of addictions represented a risk for the occurrence of inadequate or absent maternal treatment and for the occurrence of CS. Inadequate or absent treatment had a negative impact on the newborn's birth conditions and birth weight. There was low adherence to outpatient follow-up, with no significant difference in the variables analyzed. Thus, it is essential to provide quality prenatal care, with early diagnosis of infection, effective treatment and monitoring, to reduce adverse events related to syphilis.