Nursing care for infants with syphilis involves the primary goal of treatment with penicillin G, comprehensive physical and diagnostic assessment, supportive care for symptoms, and extensive follow-up to ensure treatment efficacy. 

Assessment

• Physical Examination: Perform a careful physical assessment, as many infected newborns are asymptomatic at birth. Be alert for early symptoms that typically appear within the first three months, including:
• Maculopapular rash, especially on the palms and soles.
• Enlarged liver and spleen (hepatosplenomegaly).
• "Snuffles" (rhinitis with watery, bloody, or purulent nasal discharge).
• Skeletal abnormalities like osteochondritis or periostitis (painful, limited movement of an extremity, or "pseudoparalysis").
• Irritability, fever, failure to gain weight, and jaundice.
• Diagnostic Evaluation: Ensure all recommended evaluations are performed, which may include:
• Maternal serology tests (RPR or VDRL) results comparison with the infant's.
• Complete blood count (CBC) with platelet count.
• Long-bone X-rays to check for characteristic changes.
• Lumbar puncture (spinal tap) to examine cerebrospinal fluid (CSF) if neurosyphilis is suspected.
• Dark-field microscopic examination of any skin lesions or nasal discharge to directly identify the bacteria. 

Interventions and Management

• Medication Administration: Penicillin G is the only proven treatment for congenital syphilis.
• Administer aqueous crystalline penicillin G intravenously (IV) for a 10-day course in symptomatic infants or those with a high probability of infection. A single intramuscular (IM) dose of benzathine penicillin G may be an option in specific low-risk circumstances where follow-up is assured.
• If any dose is missed for more than one day, the entire course must be restarted.
• Monitor for the Jarisch-Herxheimer reaction (fever, headache, myalgias, rash) shortly after the first dose, which is an immune response to the dying bacteria.
• Symptom Management:
• Provide supportive care for specific symptoms (e.g., managing eye inflammation with drops, addressing hearing loss with potential medication/devices).
• Maintain strict hygiene and use standard precautions when handling infants with active, open lesions to prevent transmission.
• Ensure adequate nutrition, especially for infants experiencing failure to thrive. 

Education and Follow-Up

• Parental Education:
• Educate the parents about the importance of completing the full course of antibiotics and the need for rigorous follow-up.
• Provide information on preventing future syphilis infections and re-infection, including safe sex practices and the need for partners to be treated.
• Advise parents that breastfeeding is permitted as long as there are no active syphilitic lesions on the mother's breast.
• Long-term Monitoring:
• Emphasize the need for regular clinical evaluation and serologic testing (RPR/VDRL) every 2-3 months until the test becomes nonreactive, which typically happens by 6 months of age.
• Ensure all appointments with pediatric infectious disease specialists and for eye/hearing exams are kept. 

This comprehensive approach to nursing care is essential for the successful management of infants with syphilis, focusing on effective treatment and preventing long-term complications. 

This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes