Pleural effusions in the neonate

Abstract

Introduction: Pleural effusions are rare in the neonate and may be associated to several clinical conditions. Only a few series of pleural effusions in the fetus and newborn are described in the literature. Aim: This study was undertaken to determine more accurately the causes and prognostic significance of pleural effusions in a population of high‐risk neonates. Materials and methods: A retrospective chart review of 62 neonates admitted to the neonatal intensive care unit of six medical centers in the north of Portugal, between 1997 and 2004, that presented the diagnosis of pleural effusion. Results: 33M/29F newborns; preterms 47 (76%); GA 33 (25–40) wk; BW 1830 (660–4270) g; C‐section 39 (63%). Pleural effusions were congenital in 20 (32%) newborns and acquired in 42 (68%). Congenital pleural effusions occurred as fetal hydrops in 11 (18%) patients and as chylothorax in 9 (15%). In four cases of hydrops, the cause was a congenital chylothorax. Congenital chylothorax (n=13) was the most common (65%) congenital pleural effusion in this study. The incidence of congenital chylothorax was 1:8.600 deliveries and male:female ratio was 2:1. Mortality occurred in five newborns due to pulmonary hypoplasia. Traumatic (iatrogenic) were the most frequent (n=31) acquired pleural effusions. These included 8 (13%) cases of hemothorax and 8 (13%) cases of total parenteral nutrition leakage. Pleural effusions after intra‐thoracic surgery were mainly (79%) chylothoraces. There were 11 (26%) non‐iatrogenic acquired pleural effusions. No mortality was associated with acquired pleural effusions. Conclusions: Congenital pleural effusions usually occur as hydrops or congenital chylothorax. Traumatic (iatrogenic) are the most frequent acquired pleural effusions in a tertiary NICU. Pleural effusions after intra‐thoracic surgery are mainly chylothoraces. Non‐iatrogenic acquired pleural effusions are associated to several clinical conditions, and mortality is usually associated to the underlying condition.

Fetal Pleural Effusion with Supraventricular Tachycardia; Coincidence? Cause?

“…Viseral ve pariyetal duvardan plevral boşluğa filtre edilen sıvı lenfatik sistem tarafından absorbe edilir. Pulmoner venöz hidrostatik basınçta veya lenfatik basınçta artış, kan onkotik basıncında azalma, lokal doku travması veya inflamasyon plevral efüzyonla sonuçlanır (4) (1). Asemptomatikten solunum yetmezliğine kadar değişen farklı klinik seyri olabilir.…”

Chylothorax in Infants and Children

“…14 There are reports of the successful use of radiotherapy for cases in which chylothorax was refractory to surgical management. 16,17 Chylothorax can be a manifestation of Down, [18][19][20][21] Turner, [18][19][20] and Noonan syndromes. [18][19][20][22][23][24] Congenital and pulmonary lymphangiectasia occur in these syndromes.…”

“…16,17 Chylothorax can be a manifestation of Down, [18][19][20][21] Turner, [18][19][20] and Noonan syndromes. [18][19][20][22][23][24] Congenital and pulmonary lymphangiectasia occur in these syndromes. 2 Other syndromes associated with chylothorax are X-linked myotubular myopathy, 25 35 Anecdotal reports suggest that interferon a2b may be trialed in the treatment of this disease.…”

“…88 On physical examination, there is bilateral or unilateral dullness to percussion, and poor air entry. 89 Among patients with chronic chylothorax, muscle wasting, weight loss, and other signs of malnutrition can be present. 1 The patients may be compromised immunologically because of lymphocyte depletion and hypogammaglobulinemia.…”

Isolated bilateral fetal pleural effusion: diagnosed on antenatal ultrasonography

“…1 It occurs at frequency of nearly 1 in 15,000 pregnancies. 2 Prenatally it can be detected on ultrasonography (USG) which appears an anechoic peripheral space in the thorax compressing the lung fields.…”