Introduction

This study evaluates clinical outcomes of patients with infantile spasms following antecedent Neonatal hypoglycemic brain injury (NHBI).

Methods

A Retrospective study done between March 2015 – March 2018 at Santokba Durlabji  hospital, Jaipur, India. The clinical data collected included information on aetiology, neonatal history, time of onset of spasms, comorbidities, other seizure types and response to treatment.

Results

Out of 111 patients of infantile spasm seen, acquired causes were most common (66/111; 59.5%) of which preceding NHBI was the commonest (37/111; 33.3%).

Majority of post hypoglycemic spasms patients were males (34/37) and appropriate for gestation age (76%). Mean age of onset of spasms was 5.78±3.03 months. Of these, 32.4% (12/37) had other seizures preceding spasms. Nearly all patients (87%) had global developmental delay.  Cortical visual impairment (70.27%, 26/37) and autism (18.9%) were the other commonest co morbidities.  One fourth of patients were refractory to antispasm treatment. Nearly one third (32.4%) later also developed other types of seizures.

Conclusion

This retrospective study shows that neonatal hypoglycemia is a major risk factor for infantile spasms in children in India. The overwhelmingly male preponderance who were appropriate for gestational age, could suggest a genetic predisposition of Asian Males to neonatal hypoglycemia.  In this post hypoglycemic infantile spasms cohort there was also significant long term morbidity from drug refractory seizures and Neurodevelopmental sequelae.

Hence Pediatricians and Neonatologists, especially in limited resource settings should be made aware of the long term consequences of this largely preventable cause of infantile spasms.