Hospitalizations for congenital infections in Brazil's unified health system: nationwide trends and regional disparities, 2008-2024.

Background: Congenital infections cause stillbirth, prematurity, birth defects, and neonatal death, representing a major preventable cause of infant morbidity and mortality. In Brazil, data on their hospital burden remain limited. Methods: This retrospective, population-based time series study analyzed hospitalizations of infants (<12 mo) primarily associated with congenital syphilis, toxoplasmosis, rubella, cytomegalovirus, or herpes in Brazil's Unified Health System (SUS) from 2008 to 2024. Data were extracted from the SUS Hospital Information System (SIH). Hospitalizations were evaluated by annual volume, population-adjusted rates, mean and total costs, intensive care unit (ICU) use, length of stay (LOS), and in-hospital mortality, stratified by region. Temporal trends were examined using Spearman's correlation and group differences using one-way ANOVA. Results: A total of 194,531 hospitalizations were recorded, representing a 394% increase from 4,449 in 2008 to 20,971 in 2024. Congenital syphilis accounted for 88% of admissions and increased across all regions, while toxoplasmosis and cytomegalovirus rose moderately and rubella declined following immunization. National hospital expenditures reached US$49.1 million, rising 170% over the period. Mean LOS decreased modestly (-.8 d), and ICU use remained low except for herpes (up to 32%). In-hospital mortality declined from .73% to .13%, but 29.5% of patients were hospitalized outside their municipality of residence, indicating persistent regional disparities. Conclusions: Hospitalizations due to congenital infections-predominantly syphilis-have increased substantially in Brazil, reflecting gaps in prenatal screening, partner management, and maternal-child health coordination. Despite declining mortality, regional inequalities in hospitalization rates, access, and costs persist.