Etiology, Treatment, and Early Postoperative Outcomes of Neonatal Hydrocephalus

Neonatal hydrocephalus is a neurological condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) in the ventricular system of the brain, leading to increased intracranial pressure. Objective: To determine the etiology and early postoperative outcomes in neonatal hydrocephalus. Methods: This prospective observational study was conducted at the Pediatric Neurosurgery Department of the Children's Hospital and the Institute of Child Health, Multan, Pakistan, from September 2023 to March 2025. A total of 120 newborns aged 0-28 days, who were diagnosed with hydrocephalus on clinical and radiological grounds and subsequently underwent surgical intervention, were analyzed. Postoperative complications and their association with demographic and clinical characteristics were assessed up to 30 days. Data were analyzed using IBM-SPSS Statistics, version 26.0. P<0.05 was taken as significant. Results: Among 120 neonates, the mean age at presentation was 14.28 ± 7.53 days, gestational age 36.61 ± 1.93 weeks, and birth weight 2508.89 ± 375.78 grams. Preterm birth and low birth weight were seen in 64.2% and 52.5% neonates, respectively. Common etiologies included congenital (30.0%) and intraventricular hemorrhage (28.3%). Early postoperative complications occurred in 15.8%, with significantly longer hospital stays (9.21 ± 3.44 vs. 6.54 ± 1.78 days, p<0.001). Prematurity (p=0.022), low birth weight (p=0.044), maternal infection (p=0.009), congenital anomalies (p=0.033), intraventricular hemorrhage (p=0.045), and post-infectious hydrocephalus (p=0.033) were significantly associated with complications. Conclusions: In neonates with hydrocephalus undergoing surgical management, intraventricular hemorrhage, post-infectious etiologies, prematurity, low birth weight, and abnormal antenatal history were significantly associated with early postoperative complications.