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A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy
Published on: May 16, 2015
Mammillary body injury in neonatal encephalopathy: a multicentre, retrospective study
Maarten H Lequin1, Sylke J Steggerda2, Mariasavina Severino3
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. m.h.lequin@umcutrecht.nl.
Insights
Mammillary body (MB) injury is common in neonatal encephalopathy, even with normal brain scans. This highlights the need for improved imaging protocols and follow-up to assess long-term cognitive effects in affected infants.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Medical Imaging
Background:
- The mammillary bodies (MBs) are crucial for memory function.
- Their role in neonatal encephalopathy, a condition causing memory impairments, is poorly understood.
- Neonatal encephalopathy is a significant concern in infant neurology.
Purpose of the Study:
- To investigate the prevalence and characteristics of mammillary body involvement in infants with neonatal encephalopathy.
- To assess the relationship between MB abnormalities and injury severity.
- To determine the need for modified imaging protocols for MB assessment.
Main Methods:
- A multicentre retrospective study involving 219 infants with neonatal encephalopathy.
- Analysis of magnetic resonance (MR) scans from infants treated with hypothermia.
- Inclusion of data from neonatal intensive care units in the Netherlands and Italy.
Main Results:
- Abnormal MB signal was detected in approximately 40% of scanned infants.
- In half of these cases, the overall brain MRI appeared normal.
- Severe atrophy of the MBs was observed in 8 out of 18 infants with abnormal MB signals upon follow-up.
Conclusions:
- Mammillary body assessment is critical in neonatal encephalopathy, potentially requiring thinner MRI slices.
- Long-term follow-up is essential to understand the cognitive impact of MB abnormalities.
- Further research is needed on therapeutic hypothermia's role in MB injury.
Background:
The mammillary bodies (MBs) have repeatedly been shown to be critical for memory, yet little is known about their involvement in numerous neurological conditions linked to memory impairments, including neonatal encephalopathy.
Methods:
We implemented a multicentre retrospective study, assessing magnetic resonance scans of 219 infants with neonatal encephalopathy who had undergone hypothermia treatment in neonatal intensive care units located in the Netherlands and Italy.
Results:
Abnormal MB signal was observed in ~40% of infants scanned; in half of these cases, the brain appeared otherwise normal. MB involvement was not related to the severity of encephalopathy or the pattern/severity of hypoxic-ischaemic brain injury. Follow-up scans were available for 18 cases with abnormal MB signal; in eight of these cases, the MBs appeared severely atrophic.
Conclusions:
This study highlights the importance of assessing the status of the MBs in neonatal encephalopathy; this may require changes to scanning protocols to ensure that the slices are sufficiently thin to capture the MBs. Furthermore, long-term follow-up of infants with abnormal MB signal is needed to determine the effects on cognition, which may enable the use of early intervention strategies. Further research is needed to assess the role of therapeutic hypothermia in MB involvement in neonatal encephalopathy.
Impact:
The MBs are particularly sensitive to hypoxia in neonates. Current hypothermia treatment provides incomplete protection against MB injury. MB involvement is likely overlooked as it can often occur when the rest of the brain appears normal. Given the importance of the MBs for memory, it is necessary that this region is properly assessed in neonatal encephalopathy. This may require improvements in scanning protocols.
