Rising Congenital Syphilis: Newborn Outcomes and Health Equity Insights From the Vizient Clinical Data Base

Editor's note: Hannah Murphy, Lead, Analytics & Insights also contributed to this blog post.

Welcome to another installment of the Pediatric Research at Vizient blog series. This series highlights some of the latest findings in pediatric medicine from Sg2 and Vizient®, leveraging analysis from the Vizient Clinical Data Base (CDB) to support our pediatric research efforts. Access the series using the search term Pediatric Research at Vizient for previous posts on topics ranging from firearm injury trends to diabetes and coincident mental health disorders and more.

This blog post provides insights from Vizient research on national trends, disparities and neonatal outcomes among infants born with congenital syphilis (CS), findings from which were presented at the 2024 American Public Health Association National Annual Meeting and Expo, AcademyHealth 2025 Annual Research Meeting and 2025 Pediatric Academic Societies Meeting. The complete research article on which this blog post is based appears in the March 2026 issue of Hospital Pediatrics.

Congenital syphilis has reemerged as a critical and rapidly growing public health crisis in the United States. Prenatal screening for congenital syphilis enables initiation of treatment crucial for preventing transmission to the fetus, but despite long-standing prenatal screening guidelines and public health efforts, national rates of congenital syphilis have increased nearly tenfold over the past decade. Hospital-based pediatricians, neonatologists and newborn nursery teams are often on the front lines of diagnosis as well as longer-term treatment and follow-up, making CS a condition with direct clinical, workforce, access and equity implications for children’s hospitals.

To better understand the scope of the problem, this study examined nationwide inpatient data from 2019 to 2024 to assess risk factors and neonatal outcomes associated with congenital syphilis using the CDB. We analyzed over 6.7 million inpatient birth encounters, representing approximately 28% of US live births. This cohort included 6,583 infants with congenital syphilis across 777 hospitals nationwide.

Our findings underscore congenital syphilis as a growing yet preventable driver of neonatal intensive care unit (NICU) utilization and prolonged hospital stays. The following results describe outcomes observed in the neonatal population studied.

Key Finding #1: Congenital Syphilis Cases Are Rising Rapidly Despite Long-standing Screening Guidelines

Between 2019 and 2024, the prevalence of congenital syphilis among infants more than doubled, reflecting a sharp and sustained national increase despite long-standing prenatal screening guidelines. Over the same period, the number and proportion of infants with CS accompanied by documented maternal prenatal substance use also increased, rising from 22% in 2019 to nearly 30% in 2024. This parallel growth highlights the compounding role of substance use in missed prevention opportunities and escalating neonatal risk.

Trends in Congenital Syphilis Cases and Maternal Prenatal Substance Use, 2019–2024

Source: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.

Key Finding #2: Congenital Syphilis Disproportionately Affects Infants Born in Socially Vulnerable Communities

Infants diagnosed with congenital syphilis were significantly more likely to be covered by Medicaid, born to Black mothers and reside in high-vulnerability zip codes as measured by the patent pending Vizient Vulnerability Index™.* Community-level vulnerability, particularly related to health care access, education and economic stability (view our Hospital Pediatrics article for full domain-level detail), was independently associated with higher odds of congenital syphilis, underscoring the role of structural barriers beyond individual clinical risk factors.

Demographic Characteristics of the Sample With and Without Congenital Syphilis, 2019–2024

Note: Categorical variables presented as n (%); continuous variables presented as median (interquartile range [IQR]).
Source: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.

Key Finding #3: Infants With Congenital Syphilis Experience Substantially Higher Clinical Acuity and Resource Use

Newborns with congenital syphilis had longer hospital stays, markedly higher NICU admission rates and greater in-hospital mortality than infants without congenital syphilis. These differences persisted even after accounting for prematurity and maternal substance use, indicating that congenital syphilis itself is a major driver of neonatal morbidity and hospital resource utilization.

In-Hospital Outcomes Among Those With and Without Congenital Syphilis, 2019–2024

Note: Categorical variables presented as n (%); continuous presented as median (IQR).
Source: Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com.

Sg2’s Perspective

Congenital syphilis is a preventable driver of neonatal acuity that is nonetheless growing in prevalence and increasingly concentrated in communities facing social and health care access barriers. By pairing national inpatient data with a multidimensional measure of community vulnerability, this analysis adds a hospital-based operational lens through which to view the broader public health conversation on CS. These insights reinforce the need for proactive neonatal capacity planning and more targeted, upstream prevention strategies.

Hospital leaders should:

• Plan for increasing neonatal acuity and ICU demand. Monitor trends in congenital syphilis, prematurity and substance-exposed newborns to anticipate impacts on NICU census and staffing needs. Use these data to inform workforce planning, bed capacity decisions and escalation or transfer protocols.
• Strengthen perinatal networks and community partnerships to improve prevention. Deepen collaboration across obstetrics, neonatology, public health and community-based organizations to address worsening access gaps and maternity care deserts, which factor into inadequate prenatal care. Regionalized perinatal care models can help align maternal and neonatal risk with the appropriate level of care and support screening and treatment.
• Use vulnerability data to target prevention and resources. Leverage tools like the Vizient Vulnerability Index to identify geographies with elevated risk driven by barriers to health care access, education and economic stability. Layering local vulnerability data into strategic planning can support more equitable allocation of outreach, screening and care coordination resources.

Click here to access the full research article plus the Vizient presentation to the Pediatric Academic Societies meeting on this topic.

*The patent pending Vizient Vulnerability Index identifies social needs and obstacles to care in neighborhoods that may influence a person’s overall health. Public access is available here.

Sources: Murphy HR et al. Hosp Pediatr. 2026;16(3):248–255; Moseley P et al. Lancet Infect Dis. 2024;24(1):e24–e35; CDC. U.S. syphilis cases in newborns continue to increase: a 10-times increase over a decade [press release]. November 7, 2023; Vizient Clinical Data Base. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com; Vizient Vulnerability Index. Irving, TX: Vizient, Inc.; 2025. https://www.vizientinc.com; Sg2 Analysis, 2026.