High-Risk Newborns - Hydrocephalus

What is hydrocephalus?

Hydrocephalus is a condition in which there is excessive fluid in and around the brain. it occurs from a lack of absorption, blockage of flow, or overproduction of the cerebral spinal fluid (CSF) that is made inside the ventricles (fluid-filled areas) of the brain and disperses from the ventricles around the brain and spinal cord. This may result in a buildup of fluid that can cause the pressure inside of the head to increase. In a child, this causes the bones of the skull to expand and separate to a larger-than-normal appearance.

What causes hydrocephalus?

Illustration of hydrocephalus
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Hydrocephalus occurs in approximately one out of 500 births. The following are the primary reasons why hydrocephalus occurs:

Hydrocephalus can occur either as a condition present at birth (congenital), or it can be acquired later in life. When hydrocephalus isn't related to a known genetic cause, it's thought that many factors, both genetic and environmental, contribute to the condition. In a small percentage of babies, a single gene defect on the X chromosome, or another chromosome, is responsible for the condition. If a child has been born with hydrocephalus not known to be caused by a single gene defect, the chance of it occuring in another child is 1 to 5 percent.

Causes of acquired hydrocephalus may include the following:

What are the symptoms of hydrocephalus?

The following are the most common symptoms of hydrocephalus in babies. However, each baby may experience symptoms differently. Symptoms may include:

The symptoms of hydrocephalus may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is hydrocephalus diagnosed?

Hydrocephalus may be diagnosed before birth by prenatal ultrasound, a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In many cases, hydrocephalus doesn't develop until the third trimester of the pregnancy and, therefore, may not be seen on ultrasounds performed earlier in pregnancy.

The diagnosis of congenital hydrocephalus may be made at birth and after diagnostic testing. During the examination, the physician obtains a complete prenatal and birth history of the baby. He or she may also ask if there's a family history of hydrocephalus or other medical problems. The physician will also ask about developmental milestones in older babies since hydrocephalus can be associated with developmental delay. Developmental delays may require further medical follow-up for underlying problems.

The baby's head may appear larger than normal. A measurement of the circumference of the baby's head is taken and compared to a scale that can identify normal and abnormal ranges.

Diagnostic tests that may be performed to confirm the diagnosis of hydrocephalus include:

What is the treatment for hydrocephalus?

Specific treatment for hydrocephalus will be determined by your baby's physician based on:

The goal of treatment is to reduce the pressure in the baby's head and to properly drain the cerebral spinal fluid (CSF). Occasionally, medications or procedures to draw off the extra CSF may be used.

Surgery may be needed for some cases of hydrocephalus. Surgery usually involves placing a mechanical shunting device into the baby's head to help drain the extra CSF from the brain and redirect the extra fluid to another part of the body to be absorbed. A common type of shunt is the ventriculoperitoneal shunt. This directs the fluid into the cavity in the abdomen.

Illustration demonstrating ventriculoperitoneal shunt placement
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The shunt consists of three parts:

  1. A tube that is placed inside of the ventricular space
  2. A reservoir and valve to control the flow of CSF
  3. Tubing that is directed under the skin to the abdomen, or less commonly to the heart or lung area

The shunt redirects the CSF out of the head through the tubing to a location elsewhere in the body where it can absorbed. The shunt usually runs behind the ear and the tubing tunneled under the skin to the area of the abdomen, heart, or lung. Your baby's physician will determine the drainage location based on your baby's condition, age, and other factors. The abdomen is generally the first choice.

Potential complications from the shunts or surgery can include:

Symptoms of a shunt problem may include fever, vomiting , irritability, redness and swelling along the area of the tubing, or decreased alertness or lethargy.

These symptoms require prompt medical evaluation. Following surgery, you'll receive instructions on how to care for your baby at home and information about signs or symptoms requiring medical care.

Life-long considerations

Hydrocephalus can affect the brain and a baby's development. The extent of the problem is dependent on the severity of the hydrocephalus, how quickly it was treated, and the presence of brain or other organ system problems.

The key to treating hydrocephalus is early detection, treatment, and prevention of infection. A baby with hydrocephalus requires frequent medical evaluations to ensure proper shunt function. The medical team works hard with your family to provide education and guidance as your baby grows and develops.

Genetic counseling may be recommended by your baby's physician to discuss the risk for recurrence in future pregnancies, as well as prenatal testing for hydrocephalus.

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