To analyze the trends in incidence and disability-adjusted life years（DALYs）of neonatal tuberculosis in China from 1990 to 2021.

Based on the 2021 global burden of disease（GBD）study data, extracted incidence and DALYs of neonatal tuberculosis（infants aged <28 days）in China from 1990 to 2021. Using Joinpoint log-linear regression models, calculated the estimated annual percentage change（EAPC）, average annual percent change（APC）and annual percentage change（APC）by period to analyze trend variations across different drug-resistant tuberculosis types（drug-susceptible tuberculosis（DS-TB）, multidrug-resistant TB without extensive drug resistance（MDR-TB non-XDR）, and extensively drug-resistant tuberculosis（XDR-TB））.

China’s exhibited a pronounced downward trend in both incidence and DALYs of neonatal tuberculosis（incidence EAPC: -5.88%, AAPC: -4.74%; DALYs EAPC: -6.36%, AAPC: -5.23%）from 1990 to 2021. The most substantial decline occurred during 2000-2010（DALYs 2000-2003 APC: -17.65%）, but significantly slowed after 2015（DALYs 2015-2021 APC: -1.96%, P=0.229）. DS-TB incidence（AAPC: -4.72%）and DALYs（AAPC: -2.60%）similarly declined, mirroring overall epidemic patterns. A precipitous decline was observed in MDR-TB non-XDR（DALYs EAPC: -8.51%）.

Significant achievements have been made in neonatal tuberculosis control in China over the past three decades, with particularly notable reductions in the burden of DS-TB. However, the pace of tuberculosis control progress has slowed since 2013 amid escalating threats drug-resistant tuberculosis. Critical next steps include: intensified perinatal TB screening, advanced drug-resistance surveillance, molecular diagnostics deployment, and precision interventions for sustained neonatal TB burden reduction.