Congenital idiopathic non-chylous pleural effusion presenting with respiratory distress in a preterm neonate

CASE REPORTS

Congenital idiopathic non-chylous pleural effusion presenting with respiratory distress in a preterm neonate

Abdul Khader, Aiman Mohammadi.

Department of Neonatology, Niloufer Hospital for Women and Children, Osmania Medical College, Hyderabad, Telangana, India.

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Abstract
Congenital pleural effusion is a rare neonatal condition with an incidence of around 1 case per 12,000–15,000 births, that usually presents as chylothorax.¹ We report an unusual case of isolated non-chylous, unilateral pleural effusion in a neonate who developed respiratory distress at birth requiring mechanical ventilation and chest drainage. Pleural fluid analysis showed clear straw colored fluid with low triglycerides and proteins. A comprehensive workup including imaging, pleural fluid analysis, infection screen, and genetic studies failed to identify a definitive etiology. The baby was managed with therapeutic thoracentesis, respiratory support, and empirical antibiotics. The pleural effusion eventually resolved, and the infant was discharged in a good condition.

Why this article important?

* Most commonly, pleural effusion is chylous in nature. * When non-chylous pleural effusion does occur, it is usually associated with Hydrops *The occurence of idiopathic non-chylous pleural effusion, without hydrops, is quite rare. When imaging is not readily done, it is often confounded by other common cause of neonatal respiratory distress. * We explore the variety of causes that can possibly lead to non-chylous pleural effusion. * This case emphasizes the importance of early recognition, prompt drainage, and systematic etiological workup to guide management and avoid unnecessary therapies * The report illustrates the impact of secondary complications such as ventilator-associated pneumonia. * It has long-term neurodevelopmental follow-up, which adds value by highlighting outcomes in infants with prolonged respiratory illness. * Presence of genetic workup (though variants of uncertain significance only), it may help identify associated mutations in future. *By documenting diagnostic challenges, clinical course, and outcomes, this case contributes to limited evidence on non-chylous neonatal pleural effusions and may help clinicians approach similar presentations in resource-limited settings.

Summary of article

A preterm neonate, 2390 gm, born by caesarean section for breech with fetal distress presented with respiratory distress at birth requiring PPV and CPAP. Antenatal scans showed fetal growth restriction, polyhydramnios. Soon after admission, the baby developed severe respiratory distress; imaging revealed massive right pleural effusion. Therapeutic thoracentesis and intercostal drainage evacuated large volumes of serous fluid. Pleural fluid analysis confirmed a non-chylous transudative effusion. The infant improved but later developed ventilator-associated pneumonia due to Klebsiella, requiring prolonged ventilation and antibiotics. Extensive evaluation including echocardiography, TORCH testing, genetic studies and imaging did not identify a definitive cause. The baby was discharged after 41 days with adequate weight gain but mild gross motor delay; MRI showed periventricular leukomalacia.

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