By KAYLA KELLY
Each semester I’ve the privilege of guiding nursing college students by their maternal and pediatric clinicals. At first of the semester, their enthusiasm is contagious. They share tales about witnessing their first supply, serving to a brand new mom with breastfeeding, and training developmental assessments on pediatric sufferers. Because the semester progresses, I see their demeanor shift. “You had been proper, we took care of one other congenital syphilis child at the moment.” Their reflections on the medical day are a combination of feelings: frustration, anger, and disappointment, as they watch fragile infants preventing an an infection that no little one ought to ever should endure.
Once I first inform my nursing college students that they’ll doubtless look after infants born with syphilis throughout their medical rotations, they have a look at me with wide-eyed disbelief. “Didn’t we remedy syphilis within the 1950’s?” some ask. Just a few of my college students normally recall listening to in regards to the Tuskegee Research, however most don’t know that we’re nonetheless preventing (and dropping) a battle towards congenital syphilis in america at the moment.
Congenital syphilis happens when a mom transmits the an infection to her toddler throughout being pregnant or supply. It’s nearly totally preventable with well timed screening and therapy, but the variety of instances continues to rise at an alarming fee. Between 2018 and 2022, america skilled a 183% improve in congenital syphilis instances, rising from 1,328 instances to three,769. This nationwide pattern was mirrored on the state degree, with Texas reporting 179 instances in 2017 and 922 in 2022. Throughout these 5 years, the speed of infants born with congenital syphilis in Texas rose from 46.9 to 236.6 per 100,000 stay births, a pointy improve that necessitates motion.
Texas now has one of many highest congenital syphilis charges within the nation, regardless of having probably the most complete prenatal screening legal guidelines. In accordance with the Texas Department of State Health Services, coverage mandates syphilis screening at three factors throughout being pregnant:
(1) on the first prenatal go to
(2) the third trimester (however no sooner than 28 weeks)
(3) at supply
However herein lies the issue: What occurs when a girl by no means attends prenatal care? How can we attain those that by no means step into an OB/GYN workplace throughout being pregnant? Screening legal guidelines solely defend those that are capable of entry care. In 2022, over 1/3 of Texas moms whose infants had been recognized with congenital syphilis didn’t obtain any prenatal care. Every of those instances represents a failure of our present medical system, a system that must be defending probably the most weak but stays unable to succeed in those that want it most.
Socioeconomic and systemic limitations typically restrict healthcare entry for weak populations and communities. Congenital syphilis disproportionately impacts infants born to moms who expertise limited healthcare access, housing instability, poverty, maternal drug use, and inadequate prenatal care. Many ladies additionally keep away from or delay prenatal care as a result of stigma, fears of judgment from healthcare suppliers, or considerations about being examined for substance abuse.
Think about if, as a substitute of relying solely on girls to attend prenatal appointments for screening, we might establish who’s most in danger for delivering an toddler with congenital syphilis the second they work together with any a part of the healthcare system. By leveraging present digital well being report (EHR) information and synthetic intelligence (AI), we might construct predictive fashions able to forecasting maternal and toddler well being outcomes.
These fashions might incorporate issues like prenatal care utilization, zip code, and different medical information. Sufferers flagged as high-risk inside the EHR might routinely set off a nurse navigator referral for additional evaluation and care coordination. Somewhat than limiting syphilis screening to obstetric visits, this method would establish high-risk sufferers at any level of contact: the emergency division, main care, behavioral well being, substance use therapy, or group outreach clinics.
Predictive fashions have already confirmed profitable in bettering different medical outcomes corresponding to sepsis, diabetes, and even preterm birth. We have already got the EHR methods and the information wanted. We simply should develop and apply the mannequin. These success tales display that with information analytics and AI, bettering congenital syphilis outcomes will not be solely attainable, however inside attain.
At the moment, each U.S. and Texas insurance policies deal with syphilis screening necessities throughout prenatal visits. However what in regards to the girls who by no means attend conventional prenatal care? How can we defend their infants from congenital syphilis? We should critically consider our method and develop insurance policies that evolve with the realities of at the moment’s healthcare system.
Many pregnant girls search care in emergency rooms or pressing care clinics for unrelated points corresponding to UTIs, fevers, or coughs. Every of those encounters represents a possibility for healthcare suppliers to intervene and forestall the transmission of congenital syphilis. Insurance policies must be up to date to require screening at each healthcare encounter for pregnant girls who haven’t met present screening tips, and to make sure follow-up for these recognized as high-risk inside 48 hours.
As soon as high-risk sufferers are recognized by predictive modeling, geomapping may help public well being professionals successfully goal outreach efforts. This software creates visible maps that may reveal clusters of infections and spotlight hotspots the place testing, training, and group assets must be targeted. This method is usually utilized by well being departments to allocate assets to the place they’re wanted most.
Funding to construct and combine predictive modeling into EHR methods might come from state and public well being grants. As soon as developed, the continuing price of sustaining the mannequin can be minimal in comparison with the rising prices of congenital syphilis. The typical hospitalization price for an toddler born with congenital syphilis is roughly $56,802, which is sort of four times higher than an toddler with out congenital syphilis. Stopping even a small variety of instances would shortly offset the price of the funding required to develop and implement this mannequin.
The drastic rise in congenital syphilis instances represents a failure of our well being system, a failure outlined by missed alternatives for prevention. Whereas AI can by no means substitute the human aspect of compassionate caregiving, it could possibly present us with the information wanted to make an enduring affect inside weak populations and enhance maternal-infant well being outcomes.
Remaining stagnant beneath our present ineffective insurance policies borders on negligence. To have the obtainable expertise and never use it’s, in some ways, a failure to rescue. However the marriage of expertise and compassion can change this story’s ending. I consider my college students’ faces, the frustration and disbelief of their eyes. I want I might inform them this would be the final time they see a child born with congenital syphilis, however except issues change, that is solely the start.
Kayla Kelly, MSN, RN, CPN is a nursing teacher and PhD pupil on the College of Texas at Tyler
