There has been a marked increase in the number of infants admitted to neonatal intensive care units (NICUs) in Canada for treatment of congenital syphilis. We studied the impact on resource utilization from using the Centers for Disease Control (CDC) guidelines that allow use of a single-dose intramuscular benzathine penicillin G (BPG), as compared with 10-day course of intravenous penicillin G (PG), in infants considered at low risk for congenital syphilis.

This was a retrospective cohort study enrolling infants born to mothers with reactive syphilis serology and admitted for management to two Level 2 NICUs in Edmonton, Alberta, Canada, over a 2-year period. Data were extracted for key NICU resources that are used in managing these infants. We then estimated the resources that would be utilized if the entire cohort was managed per the current CDC guidelines.

Forty-nine infants met the study criteria of which 42 were treated with 10-day course of PG. Of these 42 infants, 21 (50%) met the CDC criteria for a single dose of BPG. The use of the CDC criteria to manage this cohort could have avoided 244 hospital days, 128 central line days, 168 antibiotic days related to congenital syphilis treatment, 23 long bones X-rays, and 17 lumbar punctures, for an estimated savings of CDC $ 263,000 to the provincial health system.

Using the current CDC guidelines, half of the infants exposed to maternal syphilis and treated with a 10-day course of PG in our cohort could have been managed with a single dose of BPG, resulting in a significant saving of health care resources and in hospital costs.

Cases of congenital syphilis have risen sharply in parts of Canada.

Frequent admissions of such cases in the Canadian NICUs have aggravated bed capacity challenges.

Applying the current CDC guidelines could reduce the NICU length of stay, the use of central lines, and other invasive procedures in this population.

The manuscript has been read and approved by all authors.

Received: 06 November 2025

Accepted: 08 December 2025

Accepted Manuscript online:
11 December 2025

Article published online:
23 December 2025

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