Hydrocephalus is a condition that can occur in newborns, but the risk is significantly higher in premature babies. The fragility of the brain at this stage of development makes these children more vulnerable to neurological complications, including excessive fluid accumulation in the brain.
Although the term may sound alarming to parents, modern medicine today offers effective solutions for diagnosis, monitoring and treatment, and timely intervention can make the difference between a difficult evolution and one close to normal.
To better understand this condition, we spoke with Dr. Alina Costacheneurosurgery specialist and Dr. Dana Zaciuneonatology primary doctor in Ponderas Academic Hospital.
What is hydrocephalus and why it occurs more often in premature babies
Hydrocephalus is a condition where too much fluid builds up inside the brain. This fluid, called cerebrospinal fluid, normally protects and nourishes the brain, but when it is no longer produced and eliminated in a balanced way, it begins to accumulate and put pressure on brain structures.
“Newborn hydrocephalus is the accumulation of excess cerebrospinal fluid in the ventricular system, due to an imbalance between production and resorption. The main cause is hemorrhage, which is more common in premature newborns due to the immaturity of the cerebral cortex,” says Dr. Alina Costache.
Babies born prematurely are more at risk because their brains are not fully developed. Blood vessels are more fragile and can break more easily, which can lead to small bleeds inside the brain. These bleedings can block the normal circulation of fluid and favor the occurrence of hydrocephalus.
Early signs and the importance of close monitoring
After the child reaches home, hydrocephalus does not always appear suddenly, but can develop gradually. That’s why there are some signs that parents need to pay close attention to.
“One of the most important signs is the accelerated growth of the cranial circumference. The soft area at the top of the head, called the fontanel, may appear swollen or harder than usual, even when the child is quiet. There may be prominent veins on the scalp, irritability or, on the contrary, severe sleepiness. Repeated vomiting, feeding difficulties and the fact that the child’s eyes seem to be turned downwards, so that more of the whites of the top of the eyes are visible (also called “sunset stare”), are signs that require rapid medical evaluation,” says Dr. Dana Zaciu.
In short, any visible change in the child’s head or behavior should be discussed with the doctor as soon as possible.
In parallel, regular check-ups are essential in the first years of life. These include tracking the child’s development, checking muscle tone and constantly measuring head circumference, and when needed, the doctor may recommend further investigations to see exactly what is going on in the brain.
Modern methods of diagnosis and the timing of intervention
Today, hydrocephalus can be detected quickly with the help of investigations adapted to the child’s age. One of the most used methods is ultrasound done through the fontanelle, because it does not hurt and allows doctors to see the structure of the brain.
“Transfontanel ultrasound is frequently used in infants because it is non-invasive and allows visualization of brain structures. Brain MRI is preferred for more complex evaluations, and computed tomography is used mostly in emergency situations,” says Dr. Dana Zaciu.
The treatment decision is not made immediately, but depending on the child’s progress.
“Establishing the optimal moment for surgical intervention is based on the correlation of clinical data with imaging data. The progression of ventricular dilatation, the growth rate of the head and the appearance of signs of intracranial hypertension are monitored,” says Dr. Alina Costache.
When intervention is needed, the most common solution is to fit a special tube (shunt) that helps remove excess fluid from the brain. There are also minimally invasive variants, performed endoscopically.
In some situations, when the child is too small or unstable for surgery, temporary solutions are used to drain the fluid until the definitive intervention can be done safely.
Developmental impact and the role of early recovery
The evolution of a child diagnosed with hydrocephalus can be different from case to case. Some children may have delays in motor development or coordination difficulties, while others may have problems with attention, memory or language.
“Hydrocephalus can have a variable impact on neurological and motor development. The evolution largely depends on the severity of the condition, its cause and when treatment is initiated,” says Dr. Alina Costache.
For this reason, recovery started as early as possible is essential for the child.
“Kinetotherapy, physiotherapy and early stimulation programs contribute to the development of motor skills, improving muscle tone and preventing complications. The earlier these interventions are initiated, the greater the chances of recovery,” explains Dr. Dana Zaciu.
Prognosis and the importance of multidisciplinary collaboration
A diagnosis of hydrocephalus does not automatically mean that the child’s evolution will be negative. With timely treatment and careful monitoring, many children can develop almost normally.
“The prognosis is influenced by the cause of the disease, its severity and the speed of the intervention. In many situations, children can have a favorable evolution, especially if they benefit from well-structured treatment and recovery programs,” says Dr. Alina Costache.
For things to progress well, it is essential that several doctors work together for the same child.
“Collaboration between the pediatric neurologist, neonatologist, neurosurgeon and recovery therapists is fundamental, and communication with the family allows continuous adaptation of the therapeutic plan”, explains Dr. Dana Zaciu.
Equally important is long-term monitoring, even after treatment.
“Neurological follow-up allows the early identification of possible complications or developmental delays and the adjustment of treatment according to the child’s needs,” adds Dr. Dana Zaciu.
An essential role in the child’s development is the collaboration between the specialties, but also the involvement of the family in the care and recovery process. When there is a coordinated medical team and a well-established monitoring plan, interventions can be constantly adapted to the child’s needs, increasing the chances of optimal development.
With the right information, timely intervention and constant support, hydrocephalus can be managed effectively and children can have a good evolution and a life as close to normal as possible.
From December 2025, the activity Maternity and Fetal & Neonatal Surgery Center Regina Maria takes place within the Ponderas Academic Hospital, in an integrated medical structure that allows a multidisciplinary approach to the most complex maternal-fetal cases. This milestone marks the consolidation of a medical program dedicated to prenatal interventions and advanced newborn care.
