探讨新生儿先天性梅毒的临床特点、诊断、并发症及预后。

收集首都医科大学附属北京地坛医院儿科2014年1月～2021年12月收治的共56例新生儿先天性梅毒患儿的临床资料：性别、胎龄、出生体重、分娩方式、发病日龄、诊断日龄、住院时间、母亲梅毒感染及治疗情况、临床表现、入院时实验室检查、并发症、治疗及预后进行回顾性分析。根据母亲孕期治疗情况分为孕期未全程治疗组（6例）和孕期未治疗组（50例），符合正态分布的计量资料采用 ± s进行描述，组间比较采用t检验；不符合正态分布的计量资料采用中位数（四分位数）[M（P25，P75）]进行描述，组间比较采用秩和检验；计数资料采用[例（%）]表示，组间比较采用χ²检验。

本研究共纳入新生儿先天性梅毒56例，其中男32例（57.1%），女24例（42.9%）；早产22例（39.3%），足月34例（60.7%）；56例先天性梅毒患儿的传播途径均为母婴传播，其母亲均为梅毒感染者，孕期均未进行规范的驱梅治疗。临床表现前6位：皮疹/大片脱皮（64.3%），皮肤黄染（33.9%），呕吐/纳差/腹胀（28.6%），水肿（23.2%），发热（17.9%），肝脾大（17.9%）；53例（94.6%）患儿存在并发症，其中合并贫血38例（67.9%），心肌酶升高27例（48.2%），肝功能异常27例（48.2%），低蛋白血症26例（46.4%），骨梅毒18例（32.1%），血小板减少症16例（28.6%），神经梅毒14例（25%），肺炎12例（21.4%），梅毒性肾炎6例（10.7%），败血症4例（7.1%），梅毒鼻炎3例（5.4%）。经积极驱梅、保肝、利胆以及输血等对症治疗后53例患儿病情好转出院；3例因入院时病情危重，家属放弃治疗，随访患儿出院后不久死亡。

新生儿先天性梅毒的临床表现多不典型，可合并多器官损害，皮肤损害为最常见的表现，对于母亲孕期梅毒感染及感染情况不详的患儿，应尽快完善病原学检查，做到早诊断、早治疗，以期取得良好的预后。

To investigate the clinical characteristics, diagnosis, comorbidities and prognosis of neonatal congenital syphilis (CS).

Clinical data of newborn children with congenital syphilis admitted to the Department of Pediatrics of Beijing Ditan Hospital, Capital Medical University from January 2014 to December 2021: gender, gestational age, birth weight, mode of delivery, age of onset, age of diagnosis, length of hospital stay, maternal syphilis infection and treatment, clinical manifestations, laboratory examination on admission, complications, treatment and prognosis were retrospectively analyzed. According to the mother’s treatment during pregnancy, they were divided into incomplete treatment group (6 cases) and untreated group (50 cases). SPSS 22.0 was used for data analysis. The measurement data conforming to normal distribution were described by mean ± standard deviation and comparison between groups was performed by t test. Measurement data that did not conform to normal distribution were described by [M (P25, P75)], and rank sum test was used for comparison between groups. Statistical data were represented by the number of cases (%), χ² test was used for comparison among groups, and P < 0.05 was considered significant difference.

Total of 56 cases of congenital syphilis were included in this study, including 32 males (57.1%) and 24 females (42.9%); 22 preterm infants (39.3%) and 34 full-term infants (60.7%). The transmission route of 56 cases of congenital syphilis children was mother-to-child transmission, and their mothers were all infected with syphilis. All pregnant women did not carry out standard plum exorcism treatment. The top 6 clinical manifestations were rash/large peeling (64.3%), yellow skin (33.9%), vomiting/poor appetite/abdominal distension (28.6%), edema (23.2%), fever (17.9%), liver and spleen enlargement (17.9%); 53 cases (94.6%) had complications, including 38 cases (67.9%) of anemia, 27 cases (48.2%) of elevated myocardial enzymes, 27 cases (48.2%) of abnormal liver function, 26 cases (46.4%) of hypoproteinemia, 18 cases (32.1%) of bone syphilis, 16 cases (28.6%) of thrombocytopenia. There were 14 cases of neurosyphilis (25%), 12 cases of pneumonia (21.4%), 6 cases of syphilitic nephritis (10.7%), 4 cases of sepsis (7.1%) and 3 cases of syphilitic rhinitis (5.4%). After the symptomatic treatment of active plum removal, liver protection, gallbladder and blood transfusion, 53 cases were discharged from hospital. There were 3 cases in critical condition at admission, whose families gave up treatment, and they died shortly after discharge.

The clinical manifestations of congenital syphilis in newborns are atypical and can be complicated with multiple organ systems damage. Skin damage is the most common manifestation. For children with syphilis infection and unknown infection status during pregnancy, etiological examination should be improved as soon as possible to achieve early diagnosis and treatment in order to obtain a good prognosis.