Abstract. Pneumonia is a significant cause of morbidity and mortality in children with congenital hydrocephalus, posing unique challenges in diagnosis and treatment. This study aims to explore the specific features of pneumonia progression in children born with hydrocephalus, focusing on the interplay between neurological impairments and respiratory vulnerability. Hydrocephalus, a condition characterized by the abnormal accumulation of cerebrospinal fluid in the brain, can lead to various neurological deficits, which in turn increase the susceptibility to respiratory infections, including pneumonia. The study employs a retrospective analysis of clinical data from pediatric patients diagnosed with hydrocephalus who were also treated for pneumonia. Data were collected on the clinical presentation, diagnostic methods, treatment protocols, and outcomes of pneumonia in these patients. Key findings revealed that children with hydrocephalus often present with atypical pneumonia symptoms, including lethargy, irritability, and feeding difficulties, which complicates early diagnosis. Furthermore, respiratory defense mechanisms in these children are compromised due to poor neuromuscular control and swallowing dysfunction, leading to an increased risk of aspiration pneumonia.