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TOPLINE:

Despite being in a high-resource setting, infants with congenital tuberculosis (TB) across Europe were more likely to have been born preterm and had low birth weights than those with postnatal TB, with both the groups showing substantial mortality and morbidity.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to identify infants with perinatal TB across 104 participating European healthcare institutions.
• Overall, 46 infants were included, of whom 27 had congenital TB (median age at symptom onset, 1 week) and 19 had postnatal TB (median age at symptom onset, 12 weeks).
• Congenital TB was defined as microbiologically confirmed or probable TB in infants along with the evidence of maternal urogenital TB infection, placental TB infection, hepatic granulomas in the child's liver, or symptoms appearing within the first week of life.
• Postnatal TB was defined as microbiologically confirmed or probable TB in infants ≤ 6 months of age who did not meet the criteria for congenital TB and whose mothers were deemed to have TB.

TAKEAWAY:

• Premature delivery rates were higher in infants with congenital TB than in those with postnatal TB (57.9% vs 21.1%; P = .0489), and birth weights were lower in those with congenital TB than in those with postnatal TB (median, 1680 vs 2890 g; P = .0043).
• Extrapulmonary TB (75.0% vs 8.3%; P = .0006) and miliary TB (22.7% vs 7.1%; P = .37) occurred more frequently in the congenital TB group than in the postnatal TB group.
• Interferon-gamma release assays demonstrated poor sensitivity in both the groups; however, the microbiological confirmation of TB was achieved in the majority of patients in both the groups using culture and/or polymerase chain reaction testing.
• In the overall cohort, four patients died of TB and four experienced long-term complications at discharge, including hemiparesis in two patients and neurodevelopmental delay in two patients.

IN PRACTICE:

"TB symptoms in the mother are often absent, but this should not discourage clinicians from performing investigations for TB in the infant. Also, clinicians should consider the possibility of cTB [congenital TB] even if the Cantwell criteria are not fulfilled," the authors wrote.

SOURCE:

This study was led by Florian Götzinger, Department of Paediatric and Adolescent Medicine, Klinik Ottakring, Vienna Healthcare Group & Austrian Reference Centre for Childhood Tuberculosis, Vienna, Austria. It was published online on April 19, 2025, in The Lancet Regional Health - Europe.

LIMITATIONS:

The retrospective nature of the study resulted in some missing documentation. The study team relied on imaging reports from local radiologists with limited experience in paediatric TB disease. Despite conducting the study through a large network, a limited number of identified patients meeting the inclusion criteria prevented detailed statistical analyses.

DISCLOSURES:

This study did not receive any specific funding. Several authors reported receiving financial support from pharmaceutical companies, such as bioMérieux, AstraZeneca, and Pfizer; and organisations, including the Spanish Society of Pneumology and Thoracic Surgery, European Union's Horizon 2020 research and innovation programme, and Paediatric European Network for Treatment of AIDS — Infectious Diseases.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.