Hydrocephalus in Newborns

Hydrocephalus, also known as “water on the brain,” is caused by a buildup of cerebrospinal fluid (CSF) in the brain’s hollow spaces. These hollow spaces are called ventricles, and CSF buildup in them can lead to excessive pressure on the brain. Seeking treatment is important to lower the fluid buildup and relieve pressure before damage occurs.

Children who experience a blockage of CSF, or a lack of absorption of this fluid, are at risk for developmental and health complications. Prompt treatment is important to reduce any potential long-term damage that can come from hydrocephalus. Good prenatal care may help reduce the potential for problems, but proper care is not a guarantee a child won’t be born with or later develop hydrocephalus.

During pregnancy, an ultrasound performed between 15 and 35 weeks can detect hydrocephalus. There is no treatment for hydrocephalus when a baby is in utero, so observation is the typical recommendation at that time. If the condition worsens as the fetus develops, early delivery may be necessary.

What are the symptoms of hydrocephalus?

Parents need to be aware of hydrocephalus symptoms to seek treatment for a child who may be at risk. Even if a prenatal ultrasound doesn’t show evidence of hydrocephalus, a child can still be born with it. Additionally, hydrocephalus can also develop later.

In a child younger than a year old, a bulge in the soft spot can indicate hydrocephalus. The baby’s head size may also increase. Measuring the head circumference of an infant can help determine if the baby’s brain may be at risk or if blood vessels are under pressure near the soft spot.

According to Nemours, the most common additional symptoms of hydrocephalus include:

  • Sleepiness that goes beyond normal tiredness or that makes it difficult for an infant or child to wake up
  • Unusual or increased fussiness of the infant, despite normal soothing such as feeding, burping, etc.
  • Vomiting unrelated to a change in food or drink or that can’t be traced to another type of illness
  • Loss of appetite for infants or children who ate normally previously or sudden and unexplainable disinterest in food
  • Delayed development in reaching normal milestones or a sudden inability to perform milestone tasks that had already been demonstrated
  • Eyes that always look down and don’t appear to look at objects or items of interest

If parents notice their child exhibiting these behaviors, taking them for a pediatric appointment can help rule out hydrocephalus or alert them to treat it if it’s found.

What causes hydrocephalus?

Children can be born with congenital hydrocephalus or develop acquired hydrocephalus later. Hydrocephalus may have a genetic component, as it is more common in some families. Typically, the blocking of CSF or its lack of absorption can lead to obstructive hydrocephalus. The main causes of hydrocephalus include:

  • Complications from premature birth
  • Infection during pregnancy
  • Brain infection
  • Brain tumor
  • Brain hemorrhage from injury or stroke
  • Spina bifida (incomplete spinal cord development)
  • Aqueductal stenosis (blocked flow of CSF between ventricles)

Some cases of hydrocephalus are easier to find a cause for than others. No matter the cause, though, the condition can lead to brain damage and stop babies from meeting important developmental milestones. Proper health care is crucial.

How is hydrocephalus diagnosed?
Doctor testing a toy

There are several things to look at when making a diagnosis of hydrocephalus. Sometimes the scalp veins, baby’s head size, and other factors are strong indications. In other cases, the problem might not be as outwardly obvious, but the child may exhibit other symptoms. Doctors make a diagnosis of hydrocephalus by considering:

  • Symptom information
  • An exam
  • Imaging (tomography) such as MRI (magnetic resonance imaging),
  • ultrasound, or CT scan

Neurologists and other doctors can use scans that look at the ventricles of the brain to see whether hydrocephalus is present. While hydrocephalus is commonly found in babies, older children can also develop the condition. The same basic symptoms are indicative of hydrocephalus, no matter the child’s age.

Doctors operating a pregnant woman

Treatments for Hydrocephalus

Hydrocephalus is treatable. The exact treatment depends on the child’s age and the cause of the hydrocephalus.

SSMHealth notes the following three surgeries commonly used to treat hydrocephalus.

  • Ventriculoperitoneal (VP) shunt surgery: VP shunt surgery requires a tube placed under the skin that allows CSF to travel from the brain ventricles into the abdominal cavity where the stomach and bowels sit. From the peritoneal cavity, the CSF is absorbed into the bloodstream. A shunt needs replacement as a child grows or if it stops working or becomes infected.
  • Endoscopic third ventriculostomy (ETV) surgery: ETV surgery involves making a small hole in the bottom of the ventricle. Extra CSF drains from the brain and is absorbed into the bloodstream.
  • Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC): This surgery is often the primary type of treatment for infants with hydrocephalus. It reduces the production of CSF and provides an alternate pathway for the fluid that remains. Since it combines fluid removal with fluid reduction, it can be a very effective way to improve the outlook for children who have hydrocephalus.

Additional treatments include early intervention programs that offer occupational and physical therapy. These treatments are designed to combat the slowed development that can come from hydrocephalus.

Most children are successfully treated for hydrocephalus, but they generally require ongoing medical support and multiple surgeries. Parents can help by making sure they take their children to all needed pediatric visits and follow their doctors’ recommendations.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.