Abstracts

Rationale: Hypoglycemia in newborn is common finding . It is  an important and leading cause of neonatal seizures and brain injury with subsequent development of remote symptomatic epilepsy of varying severity . We retrospectively studied the data of children with  MRIs showing neonatal hypoglycemic brain injury for  epilepsy and neudevelopmental outcome. Methods: We reviewed the children following up in neurology clinic with typical MRI features of neonatal hypoglycemic brain injury  and history of acute neurological symptoms in 1st week after birth.  Children with perinatal depression and with congenital anomalies were excluded. Details of day of symptomatic presentation/NICU admission , onset and type of epilepsy, presence of drug resistant epilepsy /epileptic encephalopathy  were noted alongwith presence of intellectual disability or developmental delay , autistic spectrum disorder, and cortical visual impairment.  Developmental and cognitive assessment was done with age  appropriate validated tests. Results: Review of 78 children (57 boys and 21 girls) with MRI showing features of neonatal hypoglycemic brain insult and history of acute neurological symptoms (seizure/ lethagy) in first week ,was done.  75% of all included children  presented on day3 with symptoms.  66/78 were low birth weight children,majority were first born . 24/78 had ceserean section delivery.Seizures were present in 91% of cases (71/78)  , mean age of seizure onset was 2.4 yr (1 mo-11yr), partial seizures were reported  in 56/78(71%) , and was most common type . Drug resistant epilepsy was noted 26/78(33%) children . Epileptic encephalopathy was present in 23%(18/78)  and 2 children had history of status epilepticus. Associated features were developmental delay ,seen in 92% of children . Moderate to severe intellectual disability was seen in one third of children(33%), cortical visual impairment  present in 40/78(51%), and squint noted in 73% of all children .  Autistic features were observed in 26/78 children . Normal developmental outcome was observed in 6/78 (8%) of children. Conclusions: Incidence of remote symptomatic seizures, drug resistant epilepsy, and epileptic encephalopathy is significantly high in children with symptomatic neonatal hypoglycemia with MRI abnormalities . It is also associated with very high risk for developmental delay,intellectual disability,autistic spectrum disorder and visual disturbances, adding to the morbidity of epilepsy. Funding: None