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Thank you all for an outstanding kickoff this month for our two new PQCNC initiatives! It was a record setting attendance for us and was remarkable given the severe weather challenges 12 hours prior to our meeting. What an inspiring kickoff to these two projects, Sepsis in Obstetrics and Care of the Late Preterm Infant.
Regarding the Care of the Late Preterm Infant (LPTI) initiative, there are several announcements.
First, IRB approval has been received for this project from the UNC IRB.
Second, the AAP has approved Maintenance of Certification credit for LPTI.
Last, we have added one additional measure to the data collection forms for infants enrolled in LPTI.
As we all have observed and heard from our speakers at the kickoff, syphilis cases in North Carolina have been rising astronomically. In North Carolina there were five times more syphilis cases in women in 2022 than in 2012. Congenital syphilis infections have also increased, from one case in 2012 to over 70 cases in 2022. In addition, in 2023 NC DPH is reporting there were 8 deaths (stillbirth or infant deaths) related to congenital syphilis. This aligns with a similar trend observed nationwide. See the graphics enclosed here, they are staggering. And they are staggering given the congenital syphilis is preventable.
While not currently an ACOG recommendation, North Carolina Public Health instructions require North Carolina hospitals to focus intensively on eliminating these preventable deaths. Specifically North Carolina guidance mandates syphilis screening for all patients admitted for delivery. The guidance for testing of pregnant patients is contained in 10A NCAC 41A .0204 CONTROL MEASURES. Given the severity of the syphilis surge, as perinatal providers we need to be acutely aware of this guidance:
“All pregnant women shall be tested for syphilis, chlamydia and gonorrhea at the first prenatal visit. All pregnant women shall be tested for syphilis between 28 and 30 weeks of gestation and at delivery. Hospitals shall determine the syphilis serologic status of the mother prior to discharge of the newborn so that if necessary the newborn can be evaluated and treated as provided in (c)(2) of this rule. This is detailed in NC Public Health Control Measure 10A NCAC 41A .0204 CONTROL MEASURES.”
All our LPTI hospital teams need to consider whether these guidelines are being adhered to, especially as it relates to all mothers being screened for syphilis on admission for delivery. If this is happening universally, the next question is do we all have the results of a screen prior to discharging infants in our newborn units or NICUs? If we do not have these results in hand at the time of discharge, as may happen in places where the screens are done but batched, what processes do we have in place to assure that infants are followed up if a screen is positive? The sad fact is that some deaths in infants last year occurred in cases where a baby was discharged home, a positive screen was returned, but the mother could not be contacted until the infant was in extremis.
LPTI will collect data on this key practice measure. We all need to consider how our maternal and newborn services are addressing this challenge. Expect future learning sessions to focus on this question.
Marty
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