Congenital syphilis requiring VA-ECMO: A case report

Congenital syphilis (CS) is a severe infection with a rising global incidence and potentially life-threatening neonatal outcomes. We present a late preterm infant exhibiting respiratory distress, hepatosplenomegaly, and systemic inflammation. Diagnosed with congenital syphilis at 12 hours of life, targeted antimicrobial was promptly initiated. Despite maximal medical management, her clinical course rapidly deteriorated into refractory shock, severe pulmonary hypertension, and multiple organ dysfunction. This necessitated venoarterial extracorporeal membrane oxygenation (VA-ECMO). The infant underwent 7 days of VA-ECMO, 19 days of renal replacement therapy and 23 days of mechanical ventilation before successfully discharging with multidisciplinary follow-up. This case underscores the devastating potential of re-emerging congenital syphilis. It also highlights VA-ECMO as a viable rescue therapy for refractory neonatal shock, emphasizing the critical need for early referral to specialized centers.