Last modified: 2018-09-09
Abstract
INTRODUCTION: Neonatal hypoglycemia (NH) is a major risk factor for epilepsy/ developmental disabilities (DD) in India. Often unavailable perinatal records make it difficult to ascertain risk factors. This prospective study attempts to ascertain risk factors for NH and determine the clinical profile neonatal hypoglycemic brain injury (NHBI).
METHODS: Consecutive infants/ childen were recruited 1)Group 1:documented NH with neonatal encephalopathy(NE) and 2)Group 2:NE with posterior cortex lesions on MRI. Relevant perinatal details were extracted from hospital records and detailed caregiver histories using a standard proforma. Past and current seizures were classified. Co-morbidities were actively ascertained and evaluated. Data from a matched control group is being collected.
RESULTS: 80% were male. Group 1 had 51 while Group 2 had 25. Inter-group characteristics were similar.. Poor feeding(75%), seizures(63%) were common presentations. Unexpectedly, 53% had normal birth weight. Ceasarean deliveries were twice as common than reported in the general population(39.5 % vs 17%). Common risk factors were IUGR(40%), improper feeding practices(36%) and early discharge(21%).
83% had epilepsy. Onset < 3 years in 80%; Focal seizures(68%), epileptic spasms(36%) were common. 32% had febrile seizures. 44% were drug resistant. Most effective AEDs were Clobazam, Levetiracetam, Lamotrigine, Valproate often in combination.
Comorbidities were noted in 69%. Autism ,intellectual disabiity, visual impairment were most prominent.
CONCLUSION: NHBI has a spectrum of epilepsy / developmental disabilities and contributes to neurological morbidity. Many risk factors identified are modifiable. Further studies are warranted to determine whether biological risk factors exist as well.