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Hydrocephalus is one of the most common congenital abnormalities affecting the nervous system, occurring in 0.3 to 2.5 per 1,000 live births. It results from obstruction of cerebrospinal fluid (CSF) pathways by a diverse range of developmental, genetic, and acquired abnormalities and can have negative consequences on the neurodevelopmental outcome of affected neonates. Historically, hydrocephalus was diagnosed after birth and managed with a shunt procedure; however, with the advent of advanced antenatal imaging techniques, it may now be detected and treated before delivery in some individuals. Moreover, surgical options for the treatment of hydrocephalus have increased over the past few decades, and temporary CSF diversion may prevent the need for permanent shunt placement. Posthemorrhagic hydrocephalus is the most common cause of hydrocephalus in the preterm newborn, but the timing of surgical intervention for this condition remains controversial. Recent evidence suggests that earlier, rather than later, intervention may have some benefits, but more data are needed to adequately inform clinical practice. Regardless of etiology or timing of diagnosis, a thorough understanding of the natural history of hydrocephalus and the range of treatment options available is needed for parental counseling, prognostication, and appropriate surgical management.

A male infant with a prenatal diagnosis of giant omphalocele and left-sided diaphragmatic eventration is noted to have skin peeling 11 days after birth. The infant was admitted to the NICU and maintained on mechanical ventilation. Chest ultrasonography on the day of birth revealed a small left pleural effusion and diaphragmatic eventration. The team placed a peripherally inserted central catheter on the second day after birth to provide parenteral nutrition for a prolonged period. The infant failed a trial of extubation 4 days after birth. On the following day, the team evaluated the infant for sepsis because of clinical instability. A complete blood cell (CBC) count demonstrated a normal white blood cell count, normal platelets, and no …

Therapeutic hypothermia (TH) mitigates the long-term effects of neuronal excitotoxicity and cell death seen in hypoxic-ischemic encephalopathy (HIE). It remains the most evidence-based therapy for HIE, but it is not without clinical controversy. The literature abounds with questions, such as “When should we start cooling—as early as the delivery room?” “Given the efficacy of TH for moderate to severe HIE when started within 6 hours of birth, can we expand the therapy to infants with mild HIE?” “What should the target temperature be?” “What is the optimal duration of treatment?” “Is early discontinuation acceptable if the examination findings normalize?” These questions about TH, its incomplete neurologic rescue, and variations in the delivery of this therapy have prompted this review. This article summarizes changing procedural considerations for TH, the level of neuromonitoring available, the use of sedation, and considerations for neuroimaging during and after TH.