To improve the clinical cognition of congenital tuberculosis in preterm infants with gestational age less than 32 weeks, and to improve the early diagnosis and treatment of the disease.

A retrospective analysis was conducted on the clinical data, diagnosis and treatment of a 27⁺² weeks of gestation of premature infant with congenital tuberculosis admitted to Dongguan Maternal and Child Health Care Hospital in October, 2023. A comprehensive search was conducted across Wanfang, CNKI and PubMed databases to identify relevant cases from January, 1976 to December, 2024 through the keyword "congenital tuberculosis", followed by a summary and analysis of all cases involving preterm infants with a gestational age of less than 32 weeks.

The male infant was born at 27⁺² weeks of gestation. At the 6th day after birth, the infant occurred recurrent respiratory apnoea and intermittent fever, which did not respond to multiple courses of antibiotic treatment. At the 30th day after birth, a diagnosis of congenital tuberculosis was identified and the infant was subsequently treated with isoniazid (15 mg·kg^-1·d^-1), rifampicin (15 mg·kg^-1·d^-1) and pyrazinamide (40 mg·kg^-1·d^-1), leading to recovery and discharge. The total course of anti-tuberculosis treatment was 6 months. Review of previous literatures and this case, a total of 23 cases of congenital tuberculosis in preterm infants with a gestational age of less than 32 weeks were identified. Among them, there were 12 male and 11 female infants; 82.6% (19/23) infants with congenital tuberculosis were in vitro fertilization, and 7 infants died, with a mortality rate of 30.4%. There were 15.8% (3/19) mothers of the children were infected with Mycobacterium tuberculosis (MTB) before delivery, 79% (15/19) mothers were not infected with MTB before delivery, but tuberculosis was diagnosed after delivery; and 5.3% (1/19) mothers were not infected with MTB before and after delivery. Children with congenital tuberculosis whose gestational age less than 32 weeks were mostly diagnosed about 1 month after birth. Common symptoms included respiratory distress (11/23, 47.8%), apnea (10/23, 43.5%), fever (9/23, 39.1%), poor response (3/23, 13%) and bradycardia (3/23, 13%).

Premature infants with gestational age less than 32 weeks have a high mortality rate of congenital tuberculosis, which is common in in vitro fertilization infants. The clinical symptoms are mostly respiratory distress, apnea, fever, poor response and bradycardia. If the mother was diagnosed with tuberculosis before or after childbirth and the child had the above symptoms, it is necessary to improve the pathogenic examination related to tuberculosis for early diagnosis and anti-tuberculosis treatment.