Dr. Ann Anderson Berry is a faculty member of the University of Nebraska Medical Center and Medical Director of the Nebraska Perinatal Quality Improvement Collaborative (NPQIC). She testified before the Nebraska Legislature’s Health and Human Services Committee on behalf of NPQIC and the Nebraska Medical Association in support of LB41 which recommends increasing maternal syphilis screening from one to three times—twice during pregnancy and at delivery to address the rise in babies born with syphilis in Nebraska.
As medical director of the Nebraska Perinatal Quality Improvement Collaborative (NPQIC), I ensure a close collaboration with all of Nebraska’s delivery hospitals, support perinatal clinicians and serve Nebraska communities. A major part of our work is implementing quality improvement initiatives designed to prevent perinatal health issues and reduce maternal and infant morbidity and mortality. Implementation of interventions that work in perinatal health care settings is a key part of this work and is driven by public health data and public health practices that have been shown to improve outcomes for mothers and infants.
Rising neonatal syphilis rates in Nebraska
The national syphilis epidemic mirrors rising neonatal syphilis rates in Nebraska and is an important medical concern. Individuals of all ages and walks of life are being diagnosed with syphilis at rates unimaginable just a few years ago. As usual, pregnancy is a high-risk situation, and in this case the consequences are severe for the neonatal population. As a neonatologist I am involved in the care of over 1,000 ill newborns a year. I treated only one case of congenital syphilis in the first 20 years of my career caring for newborns, a diagnosis so rare that I wrote a case report for the medical literature detailing the findings.
This is a sharp contrast to the past few years where our same practice has treated multiple infants (sometimes more than one at a time) needing extended (10-12 day) intensive care hospitalizations because their mothers didn’t get tested at the end of pregnancy. These are infants that would otherwise have been cared for as normal newborns.
Devastating for infants if not treated
Syphilis during pregnancy can be devastating if not diagnosed and treated, often resulting in stillbirth. If a baby survives to delivery without maternal treatment, the infection can have a profound impact on an infant’s development causing vision and hearing loss, seizures and developmental delays and disrupting skeletal and tooth development.
Syphilis is simple and inexpensive to treat with penicillin when a test is positive. But we know that in Nebraska testing for the maternal population isn’t uniformly being performed according to 2024 updated recommendations from the Center for Disease Control (CDC) and the American College of Obstetrics and Gynecology (ACOG). Syphilis can be a silent infection, moms don’t feel sick and infants at birth may not display signs of the disease. It is later in infancy after the treatment window is closed that damage presents.
Guidance from the state is needed
It can be difficult to convince communities and providers that they have rates of syphilis that warrant the work of a quality improvement project to implement best practice (three syphilis tests—two during pregnancy and one at delivery) without guidance from the state. Without a coordinated and successful intervention, we will have dozens of more Nebraska infants impacted by syphilis infections in the coming years.
Since my hospital system implemented 2024 recommended screenings, I have not needed to admit a single infant to the NICU for syphilis treatment. The screening works—it will decrease harm to infants and decrease medical care costs for the state.
Supporting updated screening will help dedicated health care professionals translate best practice guidelines into actionable care in delivery hospitals of all sizes across Nebraska. Passing LB41, introduced by State Senator Merv Riepe (Dist. 12), ensures more disease prevention, keeping Nebraska babies safer and the subsequent decrease in congenital syphilis rates will save Nebraska health care and education dollars for years to come.
