Abstract

Pleural effusions are relatively uncommon in neonates. Most often it is a marker of underlying pathology rather than diagnosis in itself. If bilateral pleural effusions are detected antenatally, this carries an extremely poor neonatal prognosis. The case below demonstrates good team working and liaison between Obstetrics and Neonatal team with prompt management which led to a favourable outcome.

Bilateral pleural effusions were detected from early gestation. Delivery was by Caesarean section at 34 weeks after the findings of absent end-diastolic flow in the uterine artery and suboptimal CTG.

Excellent communication between Obstetrics and Neonatal team ensured adequate preparation for resuscitation of this baby. Senior consultant involvement in the initial management lead to prompt treatment, including bilateral drainage of pleural effusions and high pressure ventilation to achieve oxygenation. High flow oxygen ventilation and Nitric Oxide therapy were administered for pulmonary hypertension. The effusions persisted and the milky white appearance of the fluid draining led to suspicion of chylothorax. This was confirmed on pleural fluid analysis. The baby was then transferred for a respiratory opinion at a tertiary centre.

High resolution CT scan ruled out Pulmonary Lymphangiectasia. A lung biopsy was performed that showed Pulmonary Interstitial Glycogenosis (PIG) which carries good prognosis. The baby’s effusions resolved and, following steroid therapy she was extubated and discharged home self-ventilating in air on day 56.

Antenatal and postnatal images will be included in this presentation.