Clinical Profile, Magnetic Resonance Imaging (MRI) Findings, and Neurological Outcomes in Neonatal Rotavirus Encephalitis: A Prospective Observational Study

TL;DR

This study examines neonatal rotavirus encephalitis, finding that MRI patterns predict long-term neurological outcomes.

Contribution

The study provides new clinical and MRI data on neonatal rotavirus encephalitis and its developmental consequences.

Findings

MRI abnormalities in neonatal rotavirus encephalitis strongly predict adverse neurodevelopmental outcomes.

Early-onset seizures and specific MRI signatures are key indicators of neurological impairment in affected neonates.

Abstract

Background: Rotavirus, classically an enteric pathogen, is now recognized as a neurotropic virus capable of causing neonatal encephalitis. Its neurological effects, though rare, have significant developmental consequences.

Objective: This study aimed to evaluate the clinical profile, magnetic resonance imaging (MRI) findings, and neurological outcomes in neonates with rotavirus encephalitis.

Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit of Sarji Maternal and Child Hospital, Shivamogga, India, from April 2023 to March 2025. Twenty-five neonates aged three to nine days presenting with seizures and encephalopathy were included if MRI suggested viral encephalitis and stool reverse transcriptase polymerase chain reaction (RT-PCR) was positive for rotavirus. Demographic, clinical, biochemical, and radiologic data were prospectively recorded and analyzed using Statistical Package for the Social Sciences version 24 (IBM Corp., Armonk, NY).

Results: Among 25 neonates, 13 (52%) were female and 12 (48%) were male neonates; 20 (80%) were term, and five (20%) were preterm. Nineteen (76%) were outborn, and six (24%) were inborn. Seizure onset occurred less than or equal to four days in 11 (44 %), on day 5 in eight (32%), and after day 5 in six (24%). Common accompanying symptoms were lethargy/poor feeding in 13 (52%), diarrhea or vomiting in eight (32%), and respiratory distress in five (20%). Laboratory findings showed leukocytosis in 15 (60%), thrombocytopenia in 10 (40%), hypocalcemia in five (20%), C-reactive protein positivity in seven (28%), CSF pleocytosis in 12 (48%), and protein elevation in 14 (56%). All 23 tested (100%) had stool RT-PCR-positive for rotavirus. MRI revealed symmetric periventricular±basal ganglia involvement in 14 (56%), superficial periventricular white-matter lesions in eight (32%), and extensive periventricular+deep-gray±brainstem lesions in three (12%). At discharge, 17 (68%) had hypertonia, three (12%) hypotonia, and five (20%) normal tone. At the one-year follow-up, 15 (60%) had normal development, whereas 10 (40%) had abnormal outcomes: global developmental delay in seven (28%), postencephalitic epilepsy in two (8%), and spastic cerebral palsy in one (4%). The severity of MRI abnormalities was strongly associated with adverse neurodevelopmental outcomes (p < 0.001).

Conclusion: Neonatal rotavirus encephalitis manifests with early-onset seizures and distinct MRI signatures that predict later neurological impairment. Early MRI evaluation and structured long-term developmental surveillance are crucial to improving outcomes.

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