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Updated: Aug 11, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Perioperative Mammillary Body Injury on MRI in Neonates with Severe Congenital Heart Disease
Maaike Nijman1, Johannes M P J Breur2, Lydia C A Koch3
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Mammillary body (MB) injury is common in neonates with critical congenital heart disease (CCHD), especially after surgery. This brain injury, linked to low cardiac output syndrome, requires further study for its impact on long-term memory and cognitive development.
Area of Science:
- Pediatric Cardiology
- Neuroscience
- Neonatal Intensive Care
Background:
- Neonates with critical congenital heart disease (CCHD) face risks of cognitive impairments, particularly memory deficits.
- The mammillary bodies (MB) are crucial brain structures for memory formation.
Purpose of the Study:
- To determine the incidence and timing of MB injury in neonates with CCHD.
- To investigate the association between MB injury and cognitive outcomes at two years of age.
Main Methods:
- Cerebral MRI scans (pre- and postoperative) were analyzed for MB injury in 96 neonates undergoing surgery within six weeks of life.
- Cognitive function was assessed at two years using the Bayley Scales of Infant and Toddler Development, Third Edition.
Main Results:
- Mammillary body injury was present in 5% preoperatively and increased to 61% postoperatively (p < 0.001).
- MB injury was associated with lower postmenstrual age and low cardiac output syndrome, both pre- and postoperatively.
- No significant differences in cognitive index scores were found between neonates with or without MB injury.
Conclusions:
- Mammillary body injury is frequent in neonatal CCHD, primarily occurring postoperatively.
- The association of MB injury with low cardiac output syndrome and lower postmenstrual age is confirmed.
- Further research is needed to understand the long-term relationship between neonatal MB injury and cognitive/memory outcomes.
Background:
Neonates with critical congenital heart disease (CCHD) are at risk for long-term cognitive impairments, including memory deficits. We aimed to assess the incidence and timing of mammillary body (MB) injury, critical memory structures, in neonates with CCHD and explore its association with cognitive outcome at 2 years of age.
Methods:
We included neonates who underwent surgery with cardiopulmonary bypass in the first 6 weeks of life. Pre- and postoperative cerebral magnetic resonance imaging were reviewed for MB injury, defined as signal change on T1-, T2-, or diffusion-weighted imaging, or atrophy. Cognitive outcomes at 2 years were measured using the Dutch Bayley Scales of Infant and Toddler Development, Third Edition.
Results:
A total of 96 neonates were included. MB injury was present in 5% preoperatively and 61% postoperatively (P < 0.001). It was not related to other acquired brain lesions. Preoperative MB injury occurred more frequently in neonates with younger postmenstrual age at birth (P = 0.002) and those who developed low cardiac output syndrome before surgery (P = 0.030). Similarly, new postoperative MB injury was associated with younger postmenstrual age at surgery (P = 0.002) as well as perioperative low cardiac output syndrome (P = 0.033). No significant differences in cognitive index scores emerged between children with neonatal MB injury and those without.
Conclusions:
MB injury is frequent in neonatal CCHD, predominantly postoperatively, and is associated with low cardiac output syndrome and younger postmenstrual age. The relationship between neonatal MB injury and cognitive and memory outcomes later in life warrants further study.
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