1277 CONGENITAL CHYLOTHORAX-THREE CASES PRESENTING WITH EDEMA OF THE THORAX AND ABDOMEN

Three infants with congenital chylothorax have recently presented. Two of these were full-term females and the third was a 36 week male. Each pregnancy was uncomplicated and had spontaneous vertex vaginal deliveries. Immediately after birth each infant had severe respiratory distress requiring intubation and ventilation. Each showed significant edema limited to the chest wall and trunk with no other physical anomalies. The chest x-ray in each case revealed large bilateral pleural effusions. Chest tubes were inserted and >200 cc of serous fluid containing >3,000 WBC(98% lymphs) was drained from each thorax. With the removal of the fluid, 2 of the 3 infants improved markedly with both edema and respiratory distress resolving within 5 days. There was no recurrence of fluid even after feedings were begun. The premature male continued to require maximal respiratory support and died of respiratory failure at 12 days. The histopathology of his lung revealed changes consistent with bronchopulmonary dysplasia. In summary, congenital chylothorax must be considered in a newborn with respiratory distress, pleural effusions and edema limited to the thorax and abdomen.