Hydrocephalus in Babies

Hydrocephalus is a condition which affects the brain of the child, usually right from birth. It is one of the most common diseases that affect the central nervous system, with around 2 children out of a thousand live births being affected by this condition. In this article, let us take a deeper look at what hydrocephalus is, why it happens and how parents can effectively treat and take care of their child despite this setback.

What Is Hydrocephalus in Infants?

Hydrocephalus is a difficult condition that affects newborn babies, even though it is quite rare. Babies born with hydrocephalus have enlarged heads, due to problems with the brain at a young age. The cerebrospinal fluid is a natural part of the body which help supply nutrients to the brain and keeps it afloat by acting as a shock absorber of sorts. The brain floats in this cerebrospinal fluid present within the skull, so that it is protected from the impact on the walls of the skull. Due to the retention of surplus fluid within the skull, there occurs large swelling in the brain of the infant.

CSF is produced in the brain in the choroid plexus and is extremely important in helping it stay healthy and grow well. However, if it starts to accumulate within the skull, the result is swelling of the brain. There are channels in the brain called ventricles, and these are the ones responsible for reducing the amount of fluid in the skull. The excess amount of CSF is dumped into the bloodstream, but this does not occur in case of this condition in the babies. Therefore, swelling occurs within the skull and surgery is the only way to rectify the situation.

Types of Hydrocephalus

There are two types of hydrocephalus which affect newborn babies:

• Congenital hydrocephalus, which means that the child was born with this condition. This can occur either due to problems with the spinal cord, like deformation or the channels and ventricles in the brain not being wide enough for adequate draining of the fluid into the bloodstream.

• Acquired hydrocephalus usually occurs after the baby is born, and it can affect people of any age. This affects people over the age of 60, in many cases. Bleeding in the brain due to trauma and injuries can lead to this kind of hydrocephalus. Sometimes, children may even develop hydrocephalus owing to infections or tumours within the brain. It is sometimes hard to find the exact cause of why hydrocephalus has occurred.

Causes of Hydrocephalus in Babies

While hydrocephalus is caused due to the accumulation of the excess CSF within the skull, the reasons as to why this occurs depend upon the type of hydrocephalus.

1. Causes of Congenital Hydrocephalus

• Ventriculomegaly: In this condition, the channels which drain the fluid are much larger than normal. This leads to irregularities in the way the CSF is managed and leads to hydrocephalus.

• Aqueductal stenosis: The channels within the brain which connect the different ventricles tend to become too narrow to allow easy passage of the CSF, resulting in its accumulation within the skull.

• Arachnoid Cyst: The arachnoid layer is one of the several layers of membranes which cover the brain, and cysts may occur in this layer. These cysts are filled with the CSF, which increases the pressure on the brain due to the fluid.

• Spina Bifida: Deformation of the spinal cord and parts of the nervous system are the cause of building up of CSF in this case. This happens because the bones of the baby do not fuse properly, preventing the growth of the nervous system.

• Infections: If the mother had any severe, complicated infections during the time of pregnancy, it might result in hydrocephalus in the baby. Some diseases, like rubella and mumps, have been found to have a direct correlation with hydrocephalus in newborn babies.

2. Acquired Hydrocephalus Causes

• Intraventricular haemorrhage: In this condition, there is bleeding within the brain of the child. This leads to blood flowing within the ventricles, where it mixes with the CSF already present there. As a result, the pressure on the brain increases and leads to swelling. In newborn babies who have underdeveloped brains, the blood vessels within the brain randomly rupture to cause this condition.

• Trauma: If there are injuries to the head of the baby, bleeding might occur within the skull. This leads to a similar result, and the mixture of blood and CSF causes the fluid pressure around the brain to rise.

• Infections: Some infections which affect the central nervous system may cause inflammation of the membranes surrounding the brain, leading to improper channelling of the CSF within the skull. Therefore, the brain is unable to reabsorb the fluid, and the pressure increases.

• Tumours: If there are any CSF-filled tumours or cysts within the skull around the brain, it can also lead to hydrocephalus in the child. This is also called the non-communicating hydrocephalus.

• Communicating Hydrocephalus: Even when there are no problems with the transport of CSF within the brain, there may be problems when the CSF is made to mix with the blood. This leads to an accumulation of fluid within the skull, as the ventricles are unable to dump them out. The result is communicating hydrocephalus.

What Are the Early Signs of Hydrocephalus in Infants?

The symptoms of hydrocephalus in babies are easily noticeable- some of those are given below:

1. Swelling of the head

The dimensions of the head increase day by day, in an unnatural fashion. You will feel a soft spot at the top of the baby’s head, and the diameter of this spot will increase with each passing day. Soon, the size of the head will look disproportionate compared to the rest of his body.

2. Seams

When the skull of the child splits as a result of the expansion of the brain, parents may be able to notice some suture-like seams on the top of his head. These sutures will also seem to widen as the days pass.

3. Sun Setting of the Eyes

The eyes of the child will seem to droop permanently, and the baby will always be looking down and not moving his eyes enough.

4. Appetite Loss

Once the swelling of the brain gathers pace, the baby will feel a loss of appetite which leads to poor feeding patterns. If you try to feed him at this stage, he may try to vomit it all out quickly.

5. Irritability

Your child will start to become more irritable, and seizures at a young age will also start to become more common.

If you ever observe any one of these symptoms in your infant, you should take him to the doctor as quickly as possible.

Diagnosis and Tests

When you take him to the doctor, he will be able to diagnose the disease and arrive at the correct conclusion with the help of a few tests. These tests include:

1. Physical Examination

The first step the doctor will do is to measure the size of the baby’s head and check if it is abnormal at that age. Drooping of the eyes will also be checked, and the head is examined thoroughly. He will also check the soft spot on the skull for any swelling that has occurred.

2. Ultrasound

By placing an ultrasound probe on the top of the head, the doctor will be able to get an image of the brain inside the skull. This will help him understand the extent of the fluid buildup.

3. Computerized Tomography

Commonly known as the CT scan, this uses X-rays from different angles in order to get a 3-D image of the brain. Your child may be sedated so that he stays still during the scan (it can last for 20 minutes).

4. Magnetic Resonance Imaging

The doctor will be able to obtain extremely accurate pictures of the brain in its current condition using radio waves. This might take an hour, or as less as five minutes depending on the machine used.

5. Amniocentesis

The above tests are to diagnose the hydrocephalus in the baby after he is born. However, amniocentesis can help the doctor determine this condition before the baby is born. Using fluid from the amniotic sac, the doctor can check for any genetic mutations which might indicate a condition like Ventriculomegaly in the baby before the child is born. This way, the parents can be prepared to tackle the condition as soon as the child arrives.

Treatment for a Baby With Hydrocephalus

There are no non-invasive treatments for hydrocephalus, whether it be for older adults or for babies. The pressure within the skull needs to be released, so the procedure is sure to be invasive major surgery. There are two ways of treating hydrocephalus in children:

1. Ventriculostomy

This procedure involves a hole being made at the bottom of the ventricles so that the excess CSF in the skull can simply drain off out of the brain. The hole might also be made in between the ventricles to facilitate movement between the channels easily. This is usually carried out as an alternative treatment method to the shunt.

2. Insertion of a Shunt

This is the preferred way of treating hydrocephalus in babies. The shunt is a long tube which has a valve, which can be used to control the flow of fluid through the tube. This is inserted surgically into the brain and can help the flow of CSF at normal rates in the correct direction. The other end of this shunt is inserted into the chest or the abdominal cavity, where the CSF is more readily absorbed into the bloodstream. Therefore, the CSF flows directly out of the brain into the abdominal cavity in this case. If the child is given a shunt implant, he has to be taken to the doctor regular checkups to monitor his condition, even though the implant is a permanent one.

Other Treatment Options After Diagnosis

Since shunts are an invasive procedure and also quite dangerous, there are other treatment options which may work according to the condition of your child. These include:

• Endoscopy: Keyhole surgeries are minimally invasive, and may be the right way to go particularly if the hydrocephalus was caused due to trauma to the head. A small incision in the floor of the third ventricle is made so that the fluid drains from the brain without any blockages.

• To help further reduce the amount of CSF in the brain, the surgeon may destroy the tissue in the brain that creates the CSF- the choroid plexus. By destroying the choroid plexus using electrical current in a process called the choroid plexus coagulation, the production of CSF in the brain reduces drastically, and hydrocephalus is avoided.

• The endoscopic third ventriculostomy and the choroid plexus coagulation together can be an apt replacement for the shunt treatment in the case of many infants. Children who are affected by deformation of the spine and some other conditions can be effectively treated using this method, rather than the insertion of the shunt.

• Even after endoscopy is carried out, there should be regular checkups to monitor how the condition is progressing. If the hydrocephalus starts to occur again, a shunt has to be inserted in the brain, since endoscopy is unlikely to work in that case.

Risks and Complications Associated With Baby Hydrocephalus

As in the case of any invasive surgical procedure, there are many risks associated with treating hydrocephalus in babies. Some of these risks and limitations have been mentioned below.

Complications Due to the Surgical Treatment

• Hydrocephalus in children can recur, even after the surgical procedure is complete. The brain cannot simply stop producing the CSF, as it is an important part of the Central Nervous System. In spite of hydrocephalus, baby development is not hampered after the procedure, and they will be able to manage comfortably for the rest of their life.

• Shunt procedure is the only way to treat hydrocephalus, except if the cause is the blockage of ventricles. The insertion of a shunt is extremely complicated, and the entire stay in the hospital can amount to around three or four days. This can be hard for the child to bear.

• Shunts need to be replaced after a few years and need to be monitored frequently.

• As shunts are mechanical devices, there is a high chance that they will fail. They also become vulnerable to bacterial infections and will need to be replaced entirely if any infection takes root in the shunt.

How to Care for Your Child at Home After Surgery

Whether you diagnosed hydrocephalus in the babies in the womb or after he was born, the treatment is all the same. However, you have to ensure that you let him recover from the surgery at home so that he grows up well without anything hampering him.

• You can give your child Tylenol so that he can better manage the pain of the surgery. However, remember to check with your doctor for the right dosage before administering any medicines to him. If he is older than four years of age, your doctor might prescribe Tylenol along with Codeine for reducing the pain he feels.

• The time of the surgery will also include dietary restrictions, depending on his age and condition. However, you can give him any food he likes once he gets home after the surgery, provided the doctor has given the green light.

• Every day, you have to wash the incision of the surgery with a mild. This is the best way to ensure that the wound does not get infected until it heals. Make sure to not press on it too hard while washing, since it can be a painful ordeal for your baby.

• You have to let your child ease right back into his daily schedule, depending on how he is feeling.

• Except for the medication, the doctor will usually refrain from giving any medication to your baby.

• Until the skin gets closed and heals completely, you should not let your child stay in the water for long periods of time. The water can get into the incision and cause infections at the opening.

• After around two weeks of recuperation, you will have to take your child to the doctor for a routine check-up on the surgery.

Hydrocephalus in babies is one of the hardest things to get through, but the child can grow up to have a normal life if the condition is treated at an early stage. Even though shunts are not easy to maintain, it will not affect any other facet of the child’s life. Therefore, take your child to the doctor if you ever feel that something is wrong with the way he has been acting or growing.

Also Read: Neural Tube Birth Defect in Newborns