Term Neurological Sequelae Research Articles

Prevalence, pathogenesis and spectrum of neurological symptoms in COVID-19 and post-COVID-19 syndrome: a narrative review.

Neurological symptoms are not uncommon during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reflect a broad spectrum of neurological disorders of which clinicians should be aware. The underlying pathogenesis of neurological disease in coronavirus disease 2019 (COVID-19) may be due to four mechanisms of nervous system dysfunction and injury: i) direct viral neurological invasion; ii) immune dysregulation; iii) endothelial dysfunction and coagulopathy; and iv) severe systemic COVID-19 disease. Neurological manifestations of acute COVID-19 include headache, peripheral neuropathies, seizures, encephalitis, Guillain-Barré syndrome, and cerebrovascular disease. Commonly reported long term neurological sequelae of COVID-19 are cognitive dysfunction and dysautonomia, which despite being associated with severe acute disease are also seen in people with mild disease. Assessment of cognitive dysfunction after COVID-19 is confounded by a high prevalence of comorbid fatigue, anxiety, and mood disorders. However, other markers of neuroaxonal breakdown suggest no significant neuronal injury apart from during severe acute COVID-19. The long term impact of COVID-19 on neurological diseases remains uncertain and requires ongoing vigilance.

Uncovering a neurological protein signature for severe COVID-19

Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has sparked a global pandemic with severe complications and high morbidity rate. Neurological symptoms in COVID-19 patients, and neurological sequelae post COVID-19 recovery have been extensively reported. Yet, neurological molecular signature and signaling pathways that are affected in the central nervous system (CNS) of COVID-19 severe patients remain still unknown and need to be identified. Plasma samples from 49 severe COVID-19 patients, 50 mild COVID-19 patients, and 40 healthy controls were subjected to Olink proteomics analysis of 184 CNS-enriched proteins. By using a multi-approach bioinformatics analysis, we identified a 34-neurological protein signature for COVID-19 severity and unveiled dysregulated neurological pathways in severe cases. Here, we identified a new neurological protein signature for severe COVID-19 that was validated in different independent cohorts using blood and postmortem brain samples and shown to correlate with neurological diseases and pharmacological drugs. This protein signature could potentially aid the development of prognostic and diagnostic tools for neurological complications in post-COVID-19 convalescent patients with long term neurological sequelae.

Black Cohosh Induced Posterior Reversible Encephalopathy Syndrome (P12-5.015)

<h3>Objective:</h3> Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of reversible subcortical vasogenic edema resulting from endothelial injury due to abrupt blood pressure changes or direct effects of cytokines. PRES is characterized by encephalopathy, headaches, seizures, and visual disturbances. PRES is often seen in the setting of renal failure, autoimmune disorders, or may be induced by medications or drugs. Neuroimaging may reveal ischemic strokes, intraparenchymal hemorrhage, or sulcal subarachnoid hemorrhage. Black cohosh is a dietary supplement of the buttercup family claimed to have estrogenic effects used primarily for relief of menopausal symptoms. <h3>Background:</h3> We describe a case of a 36 year-old woman who developed PRES shortly after initiating black cohosh for the treatment of hot flashes. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 36 year-old woman with history of hypertension and uterine fibroids post hysterectomy presented with sudden onset headache. She had started taking black cohosh the day of presentation. CT brain showed a right posterior parietal intraparenchymal hemorrhage with surrounding edema and adjacent sulcal subarachnoid hemorrhage. Cerebral angiogram revealed multifocal irregularity of the right parietal branches of the MCA. The patient was started on verapamil 120mg three times daily and treated with strict blood pressure control. She was initially monitored in the neurointensive care unit and discharged home three days later. The patient was instructed to stop using black cohosh and her headache resolved over the next three weeks. Follow up cerebral angiography three months later revealed resolution of multifocal vasoconstriction of the right parietal branches. <h3>Conclusions:</h3> Early diagnosis, treatment, and discontinuation of the offending agent are important to minimize long term neurological sequelae in PRES. Review of patient medications and herbal supplements may help determine unusual triggers for PRES. Further studies are warranted to determine the association of black cohosh with PRES. <b>Disclosure:</b> Dr. Imam has nothing to disclose. Dr. Salahuddin has nothing to disclose.

Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 “long haulers”

ObjectiveCOVID-19 (SARS-CoV-2) has been associated with neurological sequelae even in those patients with mild respiratory symptoms. Patients experiencing cognitive symptoms such as “brain fog” and other neurologic sequelae for 8 or more weeks define “long haulers”. There is limited information regarding damage to grey matter (GM) structures occurring in COVID-19 “long haulers”. Advanced imaging techniques can quantify brain volume depletions related to COVID-19 infection which is important as conventional Brain MRI often fails to identify disease correlates. 3-dimensional voxel-based morphometry (3D VBM) analyzes, segments and quantifies key brain volumes allowing comparisons between COVID-19 “long haulers” and normative data drawn from healthy controls, with values based on percentages of intracranial volume.MethodsThis is a retrospective single center study which analyzed 24 consecutive COVID-19 infected patients with long term neurologic symptoms. Each patient underwent Brain MRI with 3D VBM at median time of 85 days following laboratory confirmation. All patients had relatively mild respiratory symptoms not requiring oxygen supplementation, hospitalization, or assisted ventilation. 3D VBM was obtained for whole brain and forebrain parenchyma, cortical grey matter (CGM), hippocampus, and thalamus.ResultsThe results demonstrate a statistically significant depletion of CGM volume in 24 COVID-19 infected patients. Reduced CGM volume likely influences their long term neurological sequelae and may impair post COVID-19 patient’s quality of life and productivity.ConclusionThis study contributes to understanding effects of COVID-19 infection on patient’s neurocognitive and neurological function, with potential for producing serious long term personal and economic consequences, and ongoing challenges to public health systems.

Single intrauterine death in twin pregnancy: Evidenced-based counselling and management.

Twins have a significantly higher risk of stillbirth, preterm delivery, perinatal morbidity and mortality. Single intrauterine fetal death is a relatively common and devastating occurrence for families and clinicians alike. Monochorionic twins are up to 13 times more likely to suffer an intrauterine death when compared to singletons. Additionally, longer term neurological sequelae affect monochorionic twins disproportionately. The timing of the death of the co-twin and the fetal order at the time of death have an impact on the outcome for the survivor. The risk in dichorionic pregnancies is lower with respect to neurological injury; however, the risk of prematurity remains high, particularly where the leading twin dies in utero. Recent published studies report lower rates of neurological injury in monochorionic twin pregnancies that incur an intrauterine fetal death after foetoscopic laser ablation for twin-to-twin transfusion syndrome - an important finding for patient counselling. TWEETABLE ABSTRACT: Single intrauterine fetal death in twins is a relatively common and devastating occurrence for families and clinicians alike. Adhering to collegiate guidelines will likely reduce but not eliminate the incidence of SIUD in twins.

Carbon monoxide intoxication: A report of two cases

Purpose: Here, we describe the application of non–invasive carbon monoxide monitoring for two patients with suspected carbon monoxide intoxication.&#x0D; Case reports: Since signs and symptoms are non–specific, carbon monoxide intoxication is often diagnosed only after other causes of unconsciousness have been excluded. This paper presents two cases of carbon monoxide and alcohol intoxication. From the information available (both patients were found in open spaces, unconscious, with no external signs of injury), it was impossible to infer carbon monoxide intoxication. In both cases, carbon monoxide intoxication was detected by noninvasive carbon monoxide monitoring in accordance with the ABCDE approach for the immediate assessment and treatment of critically ill patients. Other findings (blood pressure, blood sugar, etc.) did not explain the state of either patient. Both patients received oxygen therapy before the determination of carbon monoxide in the arterial blood and both were discharged after 2 days of treatment without short–term neurological sequelae. The source of carbon monoxide in each case was exposure to smoke and automobile exhaust, respectively, with concurrent alcohol intoxication.&#x0D; Conclusion: The use of devices that enable the rapid and noninvasive detection of carbon monoxide can facilitate diagnosis of carbon monoxide intoxication.

English

BACKGROUND Hypoglycaemia is one of the most common metabolic problems seen in neonatal intensive care units (NICU). Most cases of neonatal hypoglycaemia are transient and respond readily to treatment and are associated with excellent prognosis. Development of clinical signs and symptoms may be a late sign of hypoglycaemia. Persistent hypoglycaemia may result in possible neurologic sequelae. The purpose of this study was to assess the clinical pattern of hypoglycaemia in neonates admitted in special newborn care unit in Government General hospital, Mahabubnagar, Telangana and to also assess the influence of gestational age, birth weight, various comorbid conditions on blood glucose levels. METHODS This is an observational hospital-based study done in Government General Hospital, Mahabubnagar from June 2020 to May 2021. Neonates with hypoglycaemia (blood glucose &lt; 45 mg/dl) at the time of admission are included in our study. Blood glucose values were monitored 2nd hourly on 1st day and 6th hourly thereafter. Following the detection of hypoglycaemia, the neonates were treated as per institutional protocol. Clinical features, laboratory parameters are studied and analysed. RESULTS Among the 99 neonates studied, 68 (68.7 %) were males and 31 (31.3 %) females; Term babies were 75 (75.7 %) and pre term babies were 24 (24.2 %). Low birth weight newborns (51.5 %) were more affected with hypoglycaemia compared to normal weight newborns (38.4 %). Among the 99 neonates studied, 96.9 % were treated and discharged. Average duration of stay was around 05 to 07 days. CONCLUSIONS Hypoglycaemia is most common condition in neonates. Routine screening should be done to all newborns at the time of admission. Timely intervention reduces long term neurological sequelae. Neonates presenting with dull activity, refusal to feed, vomiting, jitteriness, seizures must routinely undergo regular glucose monitoring. As the study shows, most hypoglycaemic neonates presented with those symptoms. Among the various comorbidities, hypoglycaemia occurred more in birth asphyxia and respiratory distress syndrome. So, it should be made mandatory to do glucose monitoring in these cases. Glucose monitoring should be made as a common screening method to prevent morbidity and mortality in neonatal intensive care units. KEYWORDS Hypoglycaemia, Pre-Term, Term, Low Birth Weight, Special New Born Care Unit, Small for Gestational Age, Large for Gestational Age

#3104 Is dipsogenic diabetes insipidus the same condition as psychogenic polydipsia?

Objectives/AimsTraumatic brain injury is a common cause of permanent or long-term disability,1 and up to 80% of people with moderate to severe brain injury have some degree of pituitary insufficiency. Endocrine disruption has been documented in medical literature since the 1940s,2-4 where central diabetes insipidus has been described as a common transient complication which causes polydipsia (insatiable thirst). However, polydipsia can be caused by other conditions. It is classified into dipsogenic, in a syndrome of disordered thirst-regulating mechanism in patients without psychiatric disease called dipsogenic diabetes insipidus, psychogenic, as a compulsive water drinking in patients with psychiatric conditions referred to as psychogenic polydipsia or psychogenic diabetes insipidus and iatrogenic where large quantities of water are consumed for health benefits. All of which are referred to as primary polydipsia if these conditions cannot be distinguished. Dipsogenic diabetes insipidus and psychogenic polydipsia can be easily mixed up, misdiagnosed or even unrecognised, mainly because their pathophysiology is still unclear. Are these conditions different, or is there anything that can relate them to each other? With this literature review, we are aiming to find the link between subsets of polydipsia after brain trauma, to compare proposed differential diagnosis and their functionality in clinical settings.MethodA literature review was conducted following a search of MEDLINE, CINAHL Plus, APA PsycArticles, APA PsycBooks, APA PsycInfo databases from 1858 onwards.ResultsWe will present our findings from the literature review.ConclusionPolydipsia is a common clinical problem and requires careful evaluation and management to prevent long term neurological sequelae, and there are no evidence-based treatment guidelines.References National Institute of Health and Care Excellence (NICE). (2019). Head Injury. CG176. Retrieved from: https://www.nice.org.uk/guidance/cg176 Escamilla RF, Lisser H. Simmonds disease: A clinical study with revie of the literature; Differentiation from anorexia nervosa by statistical analysis of 595 cases, 101 of which were provided pathologically. The Journal of Clinical Endocrinology &amp; Metabolism 1942;2(2):6596. Porter RJ, Miller RA. Diabetes insipidus following closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry 1946;11:528562. Webb NE, Little B, Loupee-Wilson S, Power EM. Traumatic brain injury and neuro-endocrine disruption: medical and psychosocial rehabilitation. NeuroRehabilitation (Reading, Mass.) 2014;34(4):625636.

Super refractory seizures with autoimmune encephalitis and ventilator associated pneumonia: a case report

Autoimmune encephalitis is an immune-mediated syndrome with sub-acute to chronic presentations, such as memory impairment, altered sensorium, behavioral abnormality, psychosis, and seizures. Treatment as such must not be procrastinated due to pending laboratory workup, as early recognition and initiation of therapy prevents long term neurological sequelae. This is a case report of an 11-year-old male who presented with neuropsychiatric symptoms, altered sensorium and high-grade fever which evolved into refractory status epilepticus and autonomic dysfunction. While his MRI had positive findings of encephalitis, he tested negative for infectious diseases and antibody panels.

Neurological sequelae in patients with congenital cytomegalovirus

IntroductionThe infection due to cytomegalovirus is the most common congenital infection in developed countries, and one of the main causes of psychomotor impairment and neurosensory hearing loss of infectious origin.The present study has its objectives to describe the clinical-analytical and neuroimaging of patients with secondary neurological sequelae secondary to the congenital cytomegalovirus infection and then compare them with the group of patients with a congenital cytomegalovirus infection that did not have neurological symptoms during their follow-up. Material and methodsA retrospective, observational, cohort study was conducted that included all the cases of congenital cytomegalovirus infection from 2003 until 2018 and the short-medium term neurological sequelae were evaluated. Prenatal, perinatal, and postnatal data of patients with neurological sequelae were compared against those that did not present with any. ResultsA total of 60 patients with congenital cytomegalovirus infection were recorded during the study period, with 65% having neurological involvement during their follow-up period (62.2% with psychomotor impairment, 61.5% with microcephaly, 46.2% loss of hearing, 27.8% motor disorders, 20.5% epilepsy, and 5.6% with chorioretinitis). In the patient group that had sequelae, the presence of clinical symptoms during the neonatal period, as well as changes in the neuroimaging study, were the most common, with both being statistically significant compared to the asymptomatic group. The patients with neurological involvement also had a higher score on the Noyola et alneuroimaging scale. ConclusionsThe symptoms at birth, and certain findings in the neuroimaging, like the changes in the white matter or neuronal migration disorders, could predict neurocognitive sequelae in patients with congenital cytomegalovirus infection.

Evaluation of Clinical & Etiological Profile of Children with Seizures

Background: Seizures are a transient occurrence of signs and/or symptoms resulting from abnormal excessive or synchronous neuronal activity in the brain. Better understanding of seizures in terms of clinical presentation and etiology is required not only for abortion of acute attack but also for long term control of epilepsy.Subjects and Methods: This retrospective observational study included those children who were admitted with seizures within last 1 year time period of our study. Variables including age, sex, type of seizure, laboratory test results, neuroimaging, EEG findings, duration of hospital stay, diagnosis and final outcome were studied.Results: Incidence of seizures decreased with increasing age with less than 5 years age group most commonly involved. Generalized tonic clonic seizure were the most common type of seizure with febrile seizures being most common. etiology followed by CNS infections. Febrile seizures had best outcome while CNS infections had highest morbidity and mortality.Conclusion: We found CNS infections to be the most common etiology and a poor outcome. Acute episode of seizures is one of the commonest causes of hospitalization with high morbidity and mortality. Being a developing nation, strict measures to prevent infection can reduce the occurrence of seizures in children thus preventing long term neurological sequelae in children.

Study of Hypoglycemia in Neonates with Low Birth Weight

Background: Glucose metabolism disorders are common in low birth weight (LBW) infants and are associated with high morbidity and mortality. Neonatal hypoglycemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. Hypoglycemia both symptomatic and asymptomatic can lead to long term neurological sequelae. Therefore, it needs early management to prevent brain damage in a developing neonate.Subjects and Methods:This study was conducted to evaluate the prevalence and risk factors associated with hypoglycemia in low birth weight infants. Design: A hospital-based prospective longitudinal study. Duration: One year (October 2017 – October 2018). Setting: Niloufer Hospital, Hyderabad. Participants: 50 LBW neonates with birth weight less than 2500 grams. Methods: Blood glucose values were measured at the age of 1 h, 6 h, 12 h, 24 h and 48 h after delivery which was independent of feeding time. Blood glucose value less than 40 mg/dl (2.2 mmol/l) was defined as hypoglycemia. For statistical analysis, SPSS software version 20 was used.Result:Out of 50 neonates, 15(30%) had one or more episode of hypoglycemia. Overall 22 episodes were recorded. Out of 15 hypoglycemic neonates 8(53.3%) were small for gestational age (SGA) and 7(46.7%) were AGA. Sepsis was significantly noticed after hypoglycemia. The pattern of blood glucose levels was significantly different among hypoglycemic babies and normoglycemic babies over first 72 hours.Conclusion:Hypoglycemia was frequent among low birth weight babies more so in SGA babies in first 24 hours.

Study of hypoglycemia in neonates with low birth weight

Background: Glucose metabolism disorders are common in low birth weight (LBW) infants and are associated with high morbidity and mortality. Neonatal hypoglycemia, a common metabolic problem, often goes unnoticed owing to a lack of specific symptoms. Hypoglycemia both symptomatic and asymptomatic can lead to long term neurological sequelae. Therefore, it needs early management to prevent brain damage in a developing neonate. Objective: This study was conducted to evaluate the prevalence and risk factors associated with hypoglycemia in low birth weight infants. Design: A hospital-based prospective longitudinal study. Duration: One year (October 2017-October 2018). Setting: Niloufer Hospital, Hyderabad. Participants: 50 LBW neonates with birth weight less than 2500 grams. Methods: Blood glucose values were measured at the age of 1 h, 6 h, 12 h, 24 h, and 48 h after delivery which was independent of feeding time. Blood glucose value of less than 40 mg/dl (2.2 mmol/l) was defined as hypoglycemia. For statistical analysis, SPSS software version 20 was used. Results: Out of 50 neonates, 15 (30%) had one or more episodes of hypoglycemia. Overall 22 episodes were recorded. Out of 15 hypoglycemic neonates, 8 (53.3%) were small for gestational age (SGA) and 7 (46.7%) were AGA. Sepsis was significantly noticed after hypoglycemia. The pattern of blood glucose levels was significantly different among hypoglycemic babies and normoglycemic babies over the first 72 hours. Conclusion: Hypoglycemia was frequent among low birth weight babies more so in SGA babies in the first 24 hours.

S1-16 JOURNEY THROUGH REPAIR OF FRONTAL SKULL BASE ENCEPHALOCELES IN AFRICA

Introduction: The authors present the experiences of treating 10 consecutive cases of frontobasal encephaloceles in sub-saharan Africa on a floating hospital ship. To see the sustainability and feasibility of treating complex craniofacial anomolies through teamwork and mentoring of local expertise. Emphasis on telecommunications and telemedicine and radiology in the process is highlighted. Methods: 10 out of 12 encephaloceles presented were fronto-basal; male to female ratio was 7 to 3. All cases were operated by the same team of 3 surgeons - neuro, plastic and max-fac, along with an even more international team of anesthesiologist and OR personnel. Age varied from 3months to 19 yrs. Pre-operative planning was done with the help of CT with contrast and 3D recontruction to help the planning of repair and to see the associated brain anomalies. Results: All cases were operated successfully via a combined craniofacial and direct approach to repair the herniated brain and correct the cosmetic deformity with no mortality. The most common morbidity was CSF leaks ~ 70%, this was managed successfully with conservative methods which will be discussed in the presentation. we did not have established cases of post of meningitis or vranial wound infection. All patient were prophylactically given antibiotics during their hospital stay. Local wound breakdown and revision was required in two cases. Only one patient needed permanent VP shunt. There were no short to medium term neurological sequelae due to the intervention. Conclusion: It is feasible to treat complex frontal encephaloceles via a combined craniofacial approach in countries with very poor access to safe surgical care. The involvement of local expertise which included max-fac and neurosurgeon during the 4 consecutive field services helps to dissociate knowledge and skills. The model of care is one of the alternatives to manage difficult craniofacial anomalies and could be applied to other areas of complex conditions.

Glycemic status in exclusively breast fed low birth weight babies In first 72 hours of life in a teriary care hospital

Background: Neonatal hypoglycaemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. It can lead to considerable mortality and morbidity with long term neurological sequelae. Adequate breast feeding play an important role in maintaining normal glucose levels. So, this study is done to assess the incidence of hypoglycaemia in exclusively breast fed low birth weight babies, both term and preterm neonates and evaluate the impact of early breast feeding on glycaemic status upto 72 hours of life.Methods: This study was conducted over 12 month period involving 236 AGA (Appropriate for gestational age), SGA (Small for gestational age) babies with birth weight between 1.6-2.49 kg. Blood glucose values were measured at birth, 3h, 6h, 12h, 24h, 48h and 72h of life after delivery which was independent of feeding time. Hypoglycaemia was assessed against age of onset, gestational age, sex of baby, mode of delivery and time of initiation of breast feeding.Results: Total 56 episodes of hypoglycaemia were recorded in 52 babies of which 46 (27%) were term SGA babies and 6(8%) were preterm AGA babies (p=0.00148). The incidence of hypoglycaemia was found to be 22%, highest during the first 24 hours of life (93%) and delayed breast feeding is the most commonly noted risk factor (p=0.00024).Conclusions: Low birth babies are more prone to develop hypoglycaemia especially in first 24 hours of life with delayed introduction of breast feeding being one of the common risk factors and asymptomatic hypoglycaemia can be managed with frequent breast feeding without any formula feeds.

Genomic and phenotypic delineation of congenital microcephaly

Purpose:Congenital microcephaly (CM) is an important birth defect with long term neurological sequelae. We aimed to perform detailed phenotypic and genomic analysis of patients with Mendelian forms of CM.Methods:Clinical phenotyping, targeted or exome sequencing, and autozygome analysis.Results:We describe 150 patients (104 families) with 56 Mendelian forms of CM. Our data show little overlap with the genetic causes of postnatal microcephaly. We also show that a broad definition of primary microcephaly —as an autosomal recessive form of nonsyndromic CM with severe postnatal deceleration of occipitofrontal circumference—is highly sensitive but has a limited specificity. In addition, we expand the overlap between primary microcephaly and microcephalic primordial dwarfism both clinically (short stature in >52% of patients with primary microcephaly) and molecularly (e.g., we report the first instance of CEP135-related microcephalic primordial dwarfism). We expand the allelic and locus heterogeneity of CM by reporting 37 novel likely disease-causing variants in 27 disease genes, confirming the candidacy of ANKLE2, YARS, FRMD4A, and THG1L, and proposing the candidacy of BPTF, MAP1B, CCNH, and PPFIBP1.Conclusion:Our study refines the phenotype of CM, expands its genetics heterogeneity, and informs the workup of children born with this developmental brain defect.

Infection à cytomégalovirus chez la femme enceinte

With a worldwide prevalence of between 0.3 and 1 %, congenital cytomegalovirus (CMV) infection is the main cause of congenital infection. Long term neurological or audiological sequelae are seen in 20 to 25 % of infected new-borns. Congenital CMV may follow maternal primary infection or maternal non-primary infection, with comparable morbidity. The diagnosis of maternal primary infection can be done at 12 to 13 weeks gestation by serology using a 2 steps algorithm. IgG and IgM are first tested and in cases with positive IgG and IgM, IgG avidity is tested. There are no tools validated to achieve the diagnosis of maternal non-primary infection. It is therefore not advisable to prescribe a CMV serology to a already known as seropositive. Diagnosis of fetal infection relies on CMV PCR in amniotic fluid. The prognosis of an infected fetus is based upon imaging and fetal laboratory markers. At birth, diagnosis relies on CMV PCR in saliva or urine collected in the first 3 weeks. False positive particularly in saliva sample are possible, a confirmation in a second sample is mandatory. Retrospective diagnosis on dried blot spots of Guthrie cards is possible with varied sensitivity depending on the assays used. No antenatal treatment is completely validated. Valganciclovir treatment in neonates with CNS involvement has a proved albeit modest efficacy with improvement or stabilization of hearing.

Medico-legal implications of hypothermic neuroprotection in the newborn.

Hypoxic-ischemic encephalopathy (HIE) continues to be a significant source of long term neurological sequelae in infants born at or near term. In the past decade, selective head or whole body cooling has shown promising benefit in ameliorating some of the brain injury from intrapartum asphyxial insults and has become standard care in most developed countries. A decision to offer neuroprotective hypothermia (NPH) may engender subsequent litigation because it presupposes an acute intrapartum injury. Conversely, failing to offer cooling may be interpreted as a violation in the standard of care. In this paper, we review the clinical aspects of NPH and the medico-legal scenarios often seen after acute birth injury.

Hypoglycemia in low birth weight neonates: frequency, pattern, and likely determinants

Background: Hypoglycemia is the commonest metabolic disorder of neonates. If not detected in time, it can lead to considerable morbidity and mortality. Hypoglycemia both symptomatic and asymptomatic can lead to long term neurological sequelae. Therefore, it needs early management to prevent brain damage in a developing neonate. The objective to study the frequency and pattern of hypoglycemia in low birth weight neonates (LBW) and the factors associated with hypoglycemia.Methods: All neonates less than 2500 gm were carefully examined, and a detailed antenatal, natal and postnatal history was obtained. The measurement of blood glucose was estimated by glucometer by taking blood sample by prewarmed heel prick and the same time venous blood sample was sent for laboratory confirmation by glucose oxidase method. Blood glucose was estimated by glucometer at 0, 1, 2, 3, 6 and every 6 hours till 72 hours and the clinical profile of these neonates was recorded.Results: Out of 50 neonates, 12 (24%) had one or more episode of hypoglycemia overall 20 episodes were recorded 15(75%) in first 24 hours and 5(25%) between 49-72 hours all the episodes were asymptomatic. Out of 12 hypoglycemic neonates 7 (58.3%) were small for gestational age (SGA) and 5 (41.7%) were AGA (P = ns). Sepsis was significantly noticed after hypoglycemia (p = 0.00). The pattern of blood glucose levels was significantly different among hypoglycemic babies and normoglycemic babies over first72 hours.Conclusions: Hypoglycemia was frequent among low birth weight babies more so in SGA babies in first 24 hours.

Evaluation of Short Term Neurological Sequelae after Discharge and At One Month in Children Admitted with Non-Tumor Non-Traumatic Intracranial Pathology in A Tertiary Referral Teaching Centre

Evaluation of Short Term Neurological Sequelae after Discharge and At One Month in Children Admitted with Non-Tumor Non-Traumatic Intracranial Pathology in A Tertiary Referral Teaching Centre