ABSTRACT
Aim: 1) To study the outcome of hypoglycemia in neonates weighing >1500gram both symptomatic and asymptomatic having exclusively hypoglycemia with no any other medical condition known to cause brain damage , till 9 months of corrected gestational age(CGA).2) To study the clinical profile of hypoglycemia in neonates weighing >1500gram. Methods: 35 neonates weighing >1500gram with hypoglycemia (<40 mg/dl), both symptomatic and asymptomatic without any other medical condition known to cause brain damage were enrolled in the study. Hypoglycemia was confirmed with venous sample laboratory value. Both neonatal and maternal history was taken in detail, clinical examination, anthropometry was done. Follow up was done at 3, 6, 9 months of CGA for assessing neurodevelopmental outcome (motor developmental quotient i.e. MoDQ and mental developmental quotient i.e. MeDQ using DASII6 i.e. development assessment scale for Indian infants) and we did anthropometry and clinical examination, ultrasonography at discharge, electroencephalogram (EEG) done in patients with seizure, Magnetic Resonance Imaging (MRI) at 3 months, Brainstem evoked response audiometry (BERA) at 6 months, vision assessment at 9 months of CGA. Appropriate statistical analysis was done to calculate results. Results: Out of 35 enrolled cases follow up was possible in 30 cases. In our study, the prevalence of abnormal neurodevelopmental outcome according to DASII6 was 53.33% (n=16) cases with abnormal MoDQ (<70%) and 56.66% (n=17) cases with abnormal MeDQ (<70%) at 3, 6, 9 months of CGA respectively. There was statistically significant difference in the mean values of MoDQ (p value 0.014, 0.011, 0.02) and mean MeDQ (p value 0.019, 0.008, 0.02) on follow up at 3, 6, 9 months of corrected gestational age respectively between symptomatic and asymptomatic hypoglycemic cases. 8 (57.14%) symptomatic cases and 6 (37.5%) asymptomatic cases had microcephaly on follow up and the difference was not statistically significant. MRI was abnormal in 10 (71.4%) symptomatic cases and 6 (37.5%) asymptomatic cases and the difference was not statistically significant. Ultrasonography was done in all cases at discharge and it was found abnormal in 2(5.7%) cases. BERA, vision assessment and EEG was normal in all cases. Conclusion: Both symptomatic and asymptomatic hypoglycemia leads to abnormal neurodevelopmental outcome but it is more poor in symptomatic neonates as compared to asymptomatic hypoglycemia.
ABSTRACT
Objective Neurodevelopmental and behavioral assessment of very low birth weight babies (VLBW) at corrected age (CA) of 2 years. Methods 127, 110, 99 and 101 babies ≤34 weeks and ≤1500 g were followed at CA of 3, 6, 9, 12 months respectively for developmental and neurological assessment. DASII (Developmental assessment scale for Indian infants) was used at CA of 18 months and preschool behavioural checklist (PBCL) at CA 2 years. Results Of 101 VLBW babies available for follow up at CA 1 year, 3 (3%) babies had Cerebral Palsy (CP) and 3% (n=3) had suspect abnormality (mild hypotonia), 11% (n= 11) had gross motor and 8% (n=8) had language abnormality. Their mean mental (MeDQ) and motor (MoDQ) quotients were 80.4±10.7 and 77.2±13.3 and a score of<70 was found in 17% (MeDQ) and 25.7% (MoDQ) VLBW babies. High PBCL score (mean 16.8± 5.4) was seen in 84%VLBW babies. On subgroup analysis, 2 babies (5%) in subgroup1 ( n=54, ≤1200 g,) and 1 (1.6%) in subgroup 2 (n=78, 1201–1500 g) had CP. Twelve (29%) in subgroup 1 had significant language delay (p=0.004) as compared to 4 (15%) in subgroup 2 at 1 year. BSID and PBCL scores were comparable. Amongst ELBW babies (<1000 g), 6.6% (n=1) had CP, 25% (n=3) and 42% (n=5) had low MeDQ and MoDQ respectively and all of them had high PBCL score. AGA and SGA had similar outcome. Conclusion VLBW babies need close and longer follow up due to high risk of neurodevelopmental and behavioral abnormality.