Chylothorax and Other Pleural Effusions

A pleural effusion is the accumulation of fluid in the pleural space, and may represent chyle, pus, blood, transudate or other fluid. This chapter covers the pathophysiology, presentation, diagnosis and management of pleural effusions in neonates, with particular reference to the accumulation of chyle. Chylothorax is the commonest explanation for a pleural effusion in the first few days of life. It may be congenital or acquired with numerous causes. Laboratory fluid analysis, ultrasonography and plain radiography are the most important diagnostic modalities. Once diagnosed, an initial period of intestinal rest and parenteral nutrition is warranted accompanied by pleural drainage, followed by a low fat enteral feeds containing medium chain triglycerides. Nevertheless, emerging pharmacological and interventional therapies are being introduced, but surgery is reserved for when medical management fails.