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

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.