Case Report: Clinical characteristics and multidisciplinary collaborative management of congenital tuberculosis in extremely preterm twins and preterm infants: a report of three cases and literature review.

Aims: This study aims to report three cases of maternal-fetal transmission of tuberculosis in premature infants, systematically analyze their clinical characteristics, diagnostic processes, and treatment outcomes, explore the core role of the multidisciplinary team (MDT) in optimizing diagnosis and treatment, and provide an evidence-based basis for early identification, precise diagnosis, and effective therapy to reduce high mortality rates and enhance clinical management levels. Methods: Through retrospective case reports combined with a literature review, three cases of maternal-fetal transmission of tuberculosis in extremely premature twins and a premature infant were reported. Integration of maternal history, placental pathology assessment (such as acid-fast staining positive bacilli and Mycobacterium tuberculosis qPCR detection), imaging examinations (such as chest x-ray and CT), etiological tests (such as NGS), and fundus examination results. Treatment adopted individualized anti-tuberculosis regimens (isoniazid 10-15 mg/kg/d, rifampicin 15-20 mg/kg/d, pyrazinamide 20-30 mg/kg/d), collaboratively developed by MDT (neonatology, infectious diseases, pharmacists, and ophthalmology experts), combined with supportive therapies (such as mechanical ventilation, blood transfusion, and nutritional support). Follow-up evaluated growth and neurodevelopmental outcomes. Results: This study reported three cases of maternal-fetal transmission of tuberculosis, involving extremely premature twins at 27 Conclusion: The diagnosis of maternal-fetal transmission of tuberculosis in extremely premature and premature infants is highly challenging due to the lack of specific symptoms, often misdiagnosed as sepsis or respiratory distress syndrome (RDS). This study observed through three cases that integrating chest imaging, etiological tests (such as NGS), placental pathology assessment, and fundus screening (such as retinal white spot changes) aids in early diagnosis. MDT collaboration in developing individualized anti-tuberculosis treatment plans (including isoniazid, rifampicin, and pyrazinamide) supplemented with supportive therapy effectively improves infant prognosis, with normal weight gain post-discharge, good development, and no permanent visual damage. Strengthening prenatal screening and monitoring for high-risk pregnant women helps prevent such cases. In the future, multicenter studies should further optimize diagnostic criteria and treatment strategies to reduce mortality and improve neonatal quality of life.