Adverse Neurological Consequences of Neonatal Hypoglycemic Brain Injury( Nhbi): An Observational Study From India

Background: Significant brain injury due to neonatal hypoglycemia is a rarity in the developed countries but possibly under recognized in low-middle income countries. Methods: In this prospective, observational study, children visiting pediatric/ pediatric neurology outpatient department with neurological problems with history of neonatal hypoglycemia were enrolled. Clinical evaluation, epilepsy classification ( ILAE 2017) developmental assessment, autism severity assessment (IISA) and ophthalmological evaluation were done. Magnetic resonance imaging findings were reviewed by a neuroradiologist using a standard reporting proforma. Results: 195 of 229 screened children with a median age of 60 months (24 – 108) were enrolled. The median (IQR)age at hypoglycemia was 3 days. Seizures 118(61%) and lethargy 77(40%) were the commonest symptoms in newborn period. At the time of evaluation, 173 (89%) had epilepsy; 106 of 173(61%) had focal epilepsy and 67 (39%) had infantile epileptic spasms syndrome. 97 (56%) had drug refractory epilepsy. Proportion of children with below normal intellectual quotient/developmental quotient was 128/175(73%), microcephaly was seen in 137/195 (70%); while autism 48/137 (35%) and cerebral palsy 45/195 (23%) were also common. Visual impairment was seen in 123/195 (63%). On imaging review, typical parieto-occipital/occipital parenchymal changes were seen in 155(98%). Additionally, white matter changes were seen in 147(86%), thalamic changes were seen in 61(36%), posterior limb of internal capsule changes were seen in 30(18%), and cystic changes were seen in 27(16%). Conclusion: Possibly the largest data on clinical and radiological NHBI showed significant burden of adverse neuro-developmental and drug resistant epilepsy. Novel radiological findings were identified.