Neonatal pleural effusions in a Level III Neonatal Intensive Care Unit

Abstract

Pleural effusions are rare in the newborn. Still, being familiar with this condition is relevant given its association with a wide range of disorders. Only two large series of cases on this matter have been published, with no solid conclusions established. The aim of this study is to determine the etiology, management and prognosis of pleural effusions in a population of high-risk neonates.
The authors performed a retrospective study in the Neonatal Intensive Care Unit of “Hospital de São João”, Porto (Portugal), between 1997 and 2014, of all newborns with the diagnosis of pleural effusion, chylothorax, hemothorax, empyema, fetal hydrops or leakage of total parenteral nutrition (TPN).
Eighty-two newborns were included, 48 males and 34 females. Pleural effusions were congenital in 19 (23.2%) newborns and acquired in 63 (76.8%). Fetal hydrops was the most frequent cause (15 cases, 78.9%) of congenital effusions while postoperative after intrathoracic surgery was the most common cause (39 cases, 61.9%) of acquired effusions, followed by leakage of TPN (13 cases, 20.6%). Chylothorax was the most common type of effusion (41.5% of cases). Pleural effusions after intrathoracic surgery were mainly (64.1%) chylothoraces. Regarding use of octreotide for treatment of acquired chylous effusions, the comparative analysis showed no statistical differences between the group of alive newborns who received octreotide and the group who did not. Twenty-seven (32.9%) newborns died; the causes of death were related to underlying diseases and not to the pleural effusion. Clinical outcome is generally good, except in hydropic neonates. Blood albumin level appears to be predictive of prognosis and further investigation on its clinical significance should be encouraged.