{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:56:15Z","timestamp":1792688175594,"version":"4.5.0"},"reference-count":19,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Post-hemorrhagic hydrocephalus (PHH) is a major complication of extreme prematurity associated with significant neurodevelopmental morbidity. Although post-hemorrhagic ventricular dilatation (PHVD) is a recognized consequence of intraventricular hemorrhage (IVH), progression from an apparently low-grade IVH to severe shunt-dependent disease with imaging features suggestive\u2014but not diagnostic\u2014of a non-communicating hydrocephalus pattern is uncommon and presents important diagnostic and management challenges. We report such a case. Case Presentation: A male infant born at 26 weeks\u2019 gestation developed an initially documented Grade II intraventricular hemorrhage that subsequently evolved into progressive post-hemorrhagic ventricular dilatation. Serial cranial ultrasonography demonstrated progressive ventriculomegaly, later confirmed by computed tomography showing marked dilatation of the lateral and third ventricles with severe cortical mantle thinning and a relatively preserved fourth ventricle, raising suspicion of a non-communicating hydrocephalus pattern. Clinical deterioration with progressive macrocephaly and neurological manifestations necessitated temporizing ventricular cerebrospinal fluid drainage, followed by ventriculoperitoneal shunt placement after stabilization and management of secondary complications. Management throughout the clinical course relied on serial neuroimaging, multidisciplinary decision-making, and individualized neurosurgical intervention. Conclusions: This case illustrates that an apparently low-grade neonatal intraventricular hemorrhage may evolve into severe shunt-dependent PHVD and emphasizes the importance of serial neuroimaging surveillance, objective assessment of ventricular progression, and cautious interpretation of imaging findings suggestive\u2014but not diagnostic\u2014of a non-communicating hydrocephalus pattern. It further highlights the diagnostic and therapeutic challenges encountered when atypical radiological evolution complicates the management of PHVD in extremely premature infants.<\/jats:p>","DOI":"10.3390\/children13070860","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:01:17Z","timestamp":1782813677000},"page":"860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Post-Hemorrhagic Hydrocephalus with Secondary Cerebrospinal Fluid Pathway Obstruction in an Extremely Premature Infant: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8083-0491","authenticated-orcid":false,"given":"Ahmad","family":"Kharoufeh","sequence":"first","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Dalbah","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidy","family":"Alzaghal","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malak","family":"Abedi","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9379-7447","authenticated-orcid":false,"given":"Subhranshu Sekhar","family":"Kar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6948-3619","authenticated-orcid":false,"given":"Mohamed Anas","family":"Patni","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1539-6162","authenticated-orcid":false,"given":"Rajani","family":"Dube","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9863-7073","authenticated-orcid":false,"given":"Tanya","family":"Densil","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8874-7291","authenticated-orcid":false,"given":"Hussein","family":"Eleimy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Fujairah Hospital, Fujairah P.O. Box 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"242","DOI":"10.3171\/2011.12.PEDS11136","article-title":"Neonatal posthemorrhagic hydrocephalus from prematurity: Pathophysiology and current treatment concepts","volume":"9","author":"Robinson","year":"2012","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1203\/PDR.0b013e3181c1b176","article-title":"Intraventricular hemorrhage in premature infants: Mechanism of disease","volume":"67","author":"Ballabh","year":"2010","journal-title":"Pediatr. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Inder, T.E., Perlman, J.M., and Volpe, J.J. (2018). Preterm intraventricular hemorrhage\/posthemorrhagic hydrocephalus. Volpe\u2019s Neurology of the Newborn, Elsevier. [6th ed.].","DOI":"10.1016\/B978-0-323-42876-7.00024-7"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"F50","DOI":"10.1136\/adc.2010.207837","article-title":"European perspective on the diagnosis and treatment of posthemorrhagic ventricular dilatation","volume":"97","author":"Brouwer","year":"2012","journal-title":"Arch. Dis. Child. 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Neurosurg. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1071","DOI":"10.1542\/peds.2006-2841","article-title":"Randomized trial of drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation in preterm infants","volume":"119","author":"Whitelaw","year":"2007","journal-title":"Pediatrics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"F70","DOI":"10.1136\/archdischild-2017-314206","article-title":"Treatment thresholds for intervention in posthaemorrhagic ventricular dilatation: A randomised controlled trial","volume":"104","author":"Groenendaal","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_18","first-page":"305","article-title":"Risk factors for shunt dependency in posthemorrhagic hydrocephalus of prematurity","volume":"9","author":"Kestle","year":"2012","journal-title":"J. Neurosurg. 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