Observational studyPLoS medicine2023
Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study.
Observational study in PLoS medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 25 citations in OpenAlex.
- The Congenital Syphilis Surge: Clinician Lessons to Turn the Rising Tide.Advances in pediatrics · 2026Review
- The neglected role of partner treatment in congenital syphilis control in Brazil: nationwide evidence from 2007 to 2023.Lancet regional health. Americas · 2026Article
- Article
- Hospitalizations for congenital infections in Brazil's unified health system: nationwide trends and regional disparities, 2008-2024.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Spatial analysis of mortality due to congenital syphilis in Brazil from 2008 to 2022.PloS one · 2026Article
- Trends in Congenital Syphilis Incidence and Mortality in Brazil's Southeast Region: A Time-Series Analysis (2008-2022).Epidemiologia (Basel, Switzerland) · 2025Article
- Syphilis Exposure During Pregnancy and Childhood Hospital Admissions in Brazil.JAMA network open · 2025Article
- Trend in neonatal mortality and preventable neonatal deaths: a time series analysis, Bahia, 2010-2020.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2025Article
- Neonatal Infectious Disease: A Major Contributor to Infant Mortality Requiring Advances in Point-of-Care Diagnosis.Antibiotics (Basel, Switzerland) · 2024Review
- Congenital Syphilis: A Re-Emerging but Preventable Infection.Pathogens (Basel, Switzerland) · 2024Review
- Evaluation of Process Indicators and Challenges of the Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Bali Province, Indonesia (2019-2022): A Mixed Methods Study.Tropical medicine and infectious disease · 2023Article
- Estimating the real burden of gestational syphilis in Brazil, 2007-2018: a Bayesian modeling study.Lancet regional health. Americas · 2023Article
- Congenital Syphilis-An Illustrative Review.Children (Basel, Switzerland) · 2023Review
- Quality and content analysis of syphilis-related short videos on Douyin (TikTok): A cross-sectional study.Digital healthArticle
Corrections and comments
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Authors and funding
15 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundCongenital syphilis (CS) is a major and avoidable cause of neonatal death worldwide. In this study, we aimed to estimate excess all-cause mortality in children under 5 years with CS compared to those without CS. METHODS AND
findingsIn this population-based cohort study, we used linked, routinely collected data from Brazil from January 2011 to December 2017. Cox survival models were adjusted for maternal region of residence, maternal age, education, material status, self-declared race and newborn sex, and year of birth and stratified according to maternal treatment status, non-treponemal titers and presence of signs and symptoms at birth. Over 7 years, a total of 20 057 013 live-born children followed up (through linkage) to 5 years of age, 93 525 were registered with CS, and 2 476 died. The all-cause mortality rate in the CS group was 7·84/1 000 person-years compared with 2·92/1 000 person-years in children without CS, crude hazard ratio (HR) = 2·41 (95% CI 2·31 to 2·50). In the fully adjusted model, the highest under-five mortality risk was observed among children with CS from untreated mothers HR = 2·82 (95% CI 2·63 to 3·02), infants with non-treponemal titer higher than 1:64 HR = 8·87 (95% CI 7·70 to 10·22), and children with signs and symptoms at birth HR = 7·10 (95% CI 6·60 to 7·63). Among children registered with CS, CS was recorded as the underlying cause of death in 33% (495/1 496) of neonatal, 11% (85/770) of postneonatal, and 2·9% (6/210) of children 1 year of age. The main limitations of this study were the use of a secondary database without additional clinical information and the potential misclassification of exposure status.
conclusionsThis study showed an increased mortality risk among children with CS that goes beyond the first year of life. It also reinforces the importance of maternal treatment that infant non-treponemal titers and the presence of signs and symptoms of CS at birth are strongly associated with subsequent mortality.
trial registrationObservational study.
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