Neurodevelopmental follow-up of neonates with vertically transmitted Chikungunya fever has been infrequently reported. We herein report neurodevelopment follow up of two such babies at 3 year of age.

Key words: Chikungunya, Newborn, Neurodevelopment

Case 1: A 5 day old male, born at term by caesarian section with birth weight of 3.5 kg and normal apgar scores was referred with altered sensorium and convulsive apnea. On examination, he had features of encephalopathy. Mother had history of fever with joint pain few days prior to delivery. Initial work up for seizures was normal (blood glucose, serum electrolytes, CSF examination and CT scan). Septicemia was ruled out by relevant investigations (complete blood count, peripheral smear, CSF examination and blood culture sensitivity). He had hypoproteinemia and lymphedema during the hospital stay. At 1week of life, he was noticed to have hyperpigmentation over nose, face and groin. In view of maternal fever and joint pain and endemicity of the disease, baby’s and maternal blood was sent for RT PCR for chikungunya, which was positive. Hence, a final diagnosis of vertical transmission of chikungunya was considered. The baby was treated symptomatically and was discharged on direct breast feeding. The hyperpigmentation lasted two months and gradually settled.

During his initial follow up, he was found to have hypertonia for which he was advised early intervention and stimulation. He subsequently developed spastic diplegia. He also has a seizure disorder starting at 11months for which he is on 2 anticonvulsants, CT scan and EEG done at one and a half years were normal. His IQ assessment done by the Binet Kamat test of intelligence showed a score of 62 and his category of IQ was borderline. His social intelligence was age appropriate. His meaningful memory and visuo-motor skills were adequate whereas his language, nonmeaningful memory, conceptual thinking, nonverbal and numerical reasoning were inadequate. He was also found to be hyperactive for which he is on appropriate intervention.

Case 2: A 5-day-old female baby born at term with birth weight of 2.8 kg to HBsAg positive mother by caesarian section was referred with repeated convulsive apnea and lethargy since 2 days. Mother had history of high grade fever with joint pain just prior to delivery. On admission the baby had features of encephalopathy. Initial workup for seizures was normal (blood glucose and electrolytes, CSF, CT scan and EEG). Work up for septicemia was also negative. Baby was found to have hypoproteinemia and lymphedema. Baby had to be ventilated on day 4 of admission in view of repeated convulsive apnea and poor respiratory efforts. Supportive treatment was given baby and was discharged on full feeds. Babies and maternal serum for RT PCR for chikungunya positive. On day 10, baby was noticed to have perioral, limb and abdominal hyperpigmentation. On follow up, she was found to be hypotonic for which she was started on early intervention and stimulation. At 6-months of age, she was found to have poor visual regard. VEP was done and was found to be abnormal with poor NPN complexes suggestive of primary optic atrophy. BAER study done at one year of age was normal. She is presently 3 yrs and has hypotonic cerebral palsy with mental retardation. Her IQ assessment done by Binet Kamat test of Intelligence gave a score of 58 and the category of IQ was poor. Her social intelligence, visuo-motor skills, numerical reasoning and language skills were poor. Her conceptual thinking, non verbal reasoning and meaningful memory were also inadequate whereas her non meaningful memory was adequate.

In conclusion, encephalopathy appears to be the most common clinical presentation of the disease during mother to child transmission and can be associated with long term disability. Hence, newborns with vertical transmission of chikungunya need a close follow up for abnormal neurodevelopmental outcome.

Contributors: Both authors contributed to review of literature and drafting the manuscript.

Funding: None; Competing interests: None stated.

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