Unexpected pleural fluid collection in a preterm neonate

Abstract

A preterm, 26 6/7-week, 890-g male baby, was born to 39-year-old primigravida by vaginal delivery. She had preterm premature rupture of membranes at 25.6 weeks which led to severe oligohydramnios. Trial of continuation of pregnancy was attempted with amnioinfusion and continuous fetal monitoring. After 1 week trial, she went into preterm labour and delivered vaginally. Baby cried immediately after birth and received and covered in plastic bag, labour room continuous positive airway pressure was initiated and was shifted to neonatal intensive care unit for further management. He was initially started on non-invasive support and early rescue natural surfactant was given via INSURE (intubation, surfactant administration, extubation) method. In view of persistent high oxygen and increased work of breathing, the baby was intubated and started on mechanical ventilation. Umbilical vein was catheterised and tip was confirmed in inferior venae cavae. Post-natal sepsis screen was positive. On day 2 of life, the baby had clinical signs of haemodynamically significant patent ductus arteriosus (hs PDA), which was confirmed with twodimensional echocardiography, following which medical closure was carried out. At 50 h of life, the baby developed poor colour with increased ventilator requirement and chest X-ray (CXR) revealed rightsided pneumothorax (Fig. 1). An 22 G intravenous catheter was inserted in second intercostal space, however, that had to be