By KAYLA KELLY
Each semester I have the privilege of guiding nursing students through their maternal and pediatric clinics. At the beginning of the semester, their enthusiasm is contagious. They share stories about witnessing their first birth, helping a new mother with breastfeeding, and performing developmental screenings on pediatric patients. As the semester progresses, I see his behavior change. “You were right, we took care of other baby with congenital syphilis today.” Their reflections on the clinical day are a mix of emotions: frustration, anger and sadness, as they watch fragile babies fight an infection that no child should ever have to endure.
When I first tell my nursing students that they will likely care for babies born with syphilis during their clinical rotations, they look at me with wide eyes in disbelief. “Didn’t we cure syphilis in the 1950s?” some ask. Some of my students often remember hearing about the Tuskegee Study, but most have no idea that we are still fighting (and losing) a battle against congenital syphilis in the United States.
Congenital syphilis occurs when a mother passes the infection to her baby during pregnancy or childbirth. It is almost entirely preventable with early detection and treatment, but the number of cases continues to increase at an alarming rate. Between 2018 and 2022, the United States experienced a 183% increase in cases of congenital syphilis, going from 1,328 cases to 3,769. This national trend was mirrored at the state level: Texas reported 179 cases in 2017 and 922 in 2022. During those five years, the rate of babies born with congenital syphilis in Texas increased from 46.9 to 236.6 per 100,000 live births, a sharp increase that requires action.
Texas now has one of the highest rates of congenital syphilis in the country, despite having one of the most comprehensive prenatal screening laws. According to the Texas Department of State Health ServicesThe policy requires screening for syphilis at three times during pregnancy:
(1) at the first prenatal visit
(2) the third trimester (but not before 28 weeks)
(3) at the time of delivery
But here lies the problem: what happens when a woman never attends prenatal care? How can we reach those who never visit an OB/GYN office during pregnancy? Screening laws only protect those who can access care. In 2022, about 1/3 of Texas mothers whose babies were diagnosed with congenital syphilis did not receive any prenatal care. Each of these cases represents a failure of our current medical system, a system that should protect the most vulnerable but remains unable to reach those who need it most.
Socioeconomic and systemic barriers often limit access to health care for vulnerable populations and communities. Congenital syphilis disproportionately affects babies born to mothers who have it limited access to health care, housing instability, poverty, maternal drug use, and inadequate prenatal care. Many women also avoid or delay prenatal care because of stigma, fear of being judged by healthcare providers, or concerns about getting screenings. substance abuse.
Imagine if, instead of relying solely on women to attend prenatal screening appointments, we could identify who is most at risk of giving birth to a baby with congenital syphilis the moment they interact with any part of the healthcare system. Leveraging data from existing electronic health records (EHR) and artificial intelligence (AI), we could build predictive models capable of forecasting maternal and child health outcomes.
These models could incorporate elements such as prenatal care utilization, zip code, and other clinical data. Patients marked as high risk within the EHR could automatically generate a referral from a nurse navigator for further assessment and care coordination. Rather than limiting syphilis screening to obstetric visits, this approach would identify high-risk patients at any point of contact: the emergency department, primary care, behavioral health, substance abuse treatment, or community outreach clinics.
Predictive models have already proven to be successful in improving other clinical outcomes such as septicemia, diabetes, and even premature birth. We already have the EHR systems and the necessary data in place. We just have to develop and apply the model. These success stories demonstrate that with data analytics and artificial intelligence, improving congenital syphilis outcomes is not only possible, but within reach.
Currently, policies in both the US and Texas focus on syphilis screening requirements during prenatal visits. But what about women who never attend traditional prenatal care? How do we protect your babies from congenital syphilis? We must critically evaluate our approach and develop policies that evolve with the realities of today’s healthcare system.
Many pregnant women seek care at emergency rooms or urgent care clinics for unrelated problems, such as urinary tract infections, fever, or cough. Each of these encounters represents an opportunity for healthcare providers to intervene and prevent the transmission of congenital syphilis. Policies should be updated to require screening at every health care visit for pregnant women who have not met existing screening guidelines, and to ensure follow-up of those identified as high risk within 48 hours.
Once high-risk patients are identified through predictive modeling, geographic maps can help public health professionals effectively target outreach efforts. This tool creates visual maps that can reveal clusters of infections and highlight hotspots where testing, education, and community resources should be focused. Health departments often use this approach to allocate resources where they are needed most.
Funding to build and integrate predictive models into EHR systems could come from state and public health grants. Once developed, the ongoing cost of maintaining the model would be minimal compared to the increasing costs of congenital syphilis. The average hospital cost for a baby born with congenital syphilis is approximately $56,802, which is almost four times greater than a baby without congenital syphilis. Preventing even a small number of cases would quickly offset the cost of the investment needed to develop and implement this model.
The drastic increase in cases of congenital syphilis represents a failure of our health system, a failure defined by lost opportunities for prevention. While AI can never replace the human element of compassionate care, it can provide us with the data needed to make a lasting impact on vulnerable populations and improve maternal and child health outcomes.
Remaining stuck under our current ineffective policies borders on negligence. Having the technology available and not using it is, in many ways, a failure to rescue. But the union of technology and compassion can change the ending of this story. I think about the faces of my students, the frustration and disbelief in their eyes. I wish I could tell you that this will be the last time you see a baby born with congenital syphilis, but unless things change, this is just the beginning.
Kayla Kelly, MSN, RN, CPN is a nursing instructor and doctoral student at the University of Texas at Tyler.
