Neurodevelopmental Outcomes of Neonatal Rotavirus-Associated Leukoencephalopathy

Abstract

Rotavirus infection has been reported to be associated with neonatal seizures with a diffuse and symmetrical diffusion restriction of periventricular white matter, namely, neonatal rotavirus-associated leukoencephalopathy. The extensive white matter injury seen in this cohort raises concerns about the long-term neurodevelopmental outcomes. In the present study, we prospectively assessed the neurodevelopmental outcomes of 13 patients with neonatal rotavirus-associated leukoencephalopathy at a median age of 26 months (range, 23–68 months). Neurodevelopmental outcomes were evaluated using a neurological examination, developmental evaluations, and magnetic resonance imaging (MRI) of the brain. Overall, 6 of the 13 patients (46%) had abnormal neurodevelopmental outcomes: 1 patient had mental retardation, visual–motor integration (VMI) dysfunction, cerebral palsy, and epilepsy; 1 patient had cerebral palsy and VMI dysfunction; remaining 4 patients had VMI dysfunction. Follow-up MRI in 12 of 13 patients showed an increased signal intensity on periventricular white matter in all patients. These findings suggested that neonatal rotavirus-associated leukoencephalopathy could not be assumed to be benign in long-term neurodevelopment, particularly in VMI function. Early intervention and long-term follow-up are necessary for these patients. Our findings raise caution for rotavirus infection in this vulnerable population for infants.

Keywords

rotavirus - leukoencephalopathy - infant - seizures - prognosis

• References

• 1 Yeom JS, Kim YS, Seo JH. et al. Distinctive pattern of white matter injury in neonates with rotavirus infection. Neurology 2015; 84 (01) 21-27
• 2 Oh KW, Moon CH, Lee KY. Association of rotavirus with seizures accompanied by cerebral white matter injury in neonates. J Child Neurol 2015; 30 (11) 1433-1439
• 3 Oh KW, Lim G, Lee KY. Neonatal rotavirus-associated leukoencephalopathy is one of the main causes of fifth-day fits. J Child Neurol 2021; 36 (05) 378-384
• 4 Lee KY, Oh KW, Weon YC, Choi SH. Neonatal seizures accompanied by diffuse cerebral white matter lesions on diffusion-weighted imaging are associated with rotavirus infection. Eur J Paediatr Neurol 2014; 18 (05) 624-631
• 5 Yeom JS, Park JS, Kim YS. et al. Neonatal seizures and white matter injury: role of rotavirus infection and probiotics. Brain Dev 2019; 41 (01) 19-28
• 6 Lee KY, Weon YC, Choi SH, Oh KW, Park H. Neurodevelopmental outcomes in newborns with neonatal seizures caused by rotavirus-associated leukoencephalopathy. Seizure 2018; 56: 14-19
• 7 Verboon-Maciolek MA, Truttmann AC, Groenendaal F. et al. Development of cystic periventricular leukomalacia in newborn infants after rotavirus infection. J Pediatr 2012; 160 (04) 170.e1
• 8 Ku JK, Heo YJ, Lee KS, Lee BL. Clinical findings and neurologic outcome in neonatal encephalopathy with white matter injury accompanied by rotavirus. J Child Neurol 2018; 33 (04) 297-305
• 9 Park HM, Koo BK. Developmental Test of Visual-Motor Integration. Seoul: Teuksugyoyuk; 1990
• 10 Beery KE. Developmental Test of Visual-Motor Integration. Rev. ed.. Cleveland, OH: Modern Curriculum Press; 1982
• 11 Bax M, Goldstein M, Rosenbaum P. et al; Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005; 47 (08) 571-576
• 12 Kobayashi S, Fujimoto S, Fukuda S. et al. Periventricular leukomalacia with late-onset circulatory dysfunction of premature infants: correlation with severity of magnetic resonance imaging findings and neurological outcomes. Tohoku J Exp Med 2006; 210 (04) 333-339
• 13 Skranes J, Vangberg TR, Kulseng S. et al. Clinical findings and white matter abnormalities seen on diffusion tensor imaging in adolescents with very low birth weight. Brain 2007; 130 (Pt 3): 654-666
• 14 Hopkins S, Black AA, White SLJ, Wood JM. Visual information processing skills are associated with academic performance in Grade 2 school children. Acta Ophthalmol 2019; 97 (08) e1141-e1148
• 15 Memisevic H, Sinanovic O. Predictors of visual-motor integration in children with intellectual disability. Int J Rehabil Res 2012; 35 (04) 372-374