Version July 2025
MCT: medium-chain triglycerides; TPN: total parenteral nutrition.
* Chronic pleural effusions in the neonate are defined as those requiring repeated needle aspirations to relieve respiratory distress.
¶ We place an indwelling catheter for slow, continuous fluid drainage using an underwater seal system. In neonates, chest tubes in a size range of 10 to 12 French or pigtail catheters of 8.5 French or greater should be used (we prefer the latter). Additional details regarding chest tube/catheter placement and assessment of fluid composition are provided in the related UpToDate content.
Δ For neonates with resolved nonchylous effusion, following discontinuation of needle aspiration or chest tube/catheter, we follow the neonate clinically for at least 1 week to ensure resolution of symptoms and effusion. We obtain chest radiographs to confirm resolution of effusion.
◊ Monitoring and replacement of fluid losses involves frequent assessment of weight, electrolytes, albumin, and total protein, and administration of normal saline or other fluids, depending on the composition and volume of the pleural fluid drained.
§ In neonates who cannot tolerate enteral feeds or who continue to have chyle drainage for more than a week while on enteral feeds, we withhold feeds (nothing by mouth) and initiate TPN. We resume enteral feeds once chyle drainage decreases by 25% or once the neonate can tolerate feeds.
¥ Other interventions for refractory pleural effusions include surgical management and pleurodesis. These and other interventions for chylous effusions are discussed in the related UpToDate content.
‡ For neonates with resolved chylous effusion (ie, resolved drainage and effusion on chest radiographs) following dietary intervention, we discontinue the chest tube/catheter and monitor the neonate for an additional 1 to 2 weeks. We then initiate feeds with maternal or donor human milk (or standard formula if human milk is not available).
† We continue to monitor the neonate for at least another week for recurrence of a pleural effusion, including assessing T cell lymphocytes and immunoglobulins until they reach normal or near normal concentrations.
** We don't routinely use octreotide in neonates with chylous effusion given the risks of adverse events and limited benefits. However, octreotide may be an option for chylous effusions refractory to dietary management. Additional details regarding initial dosing, dose titration, and monitoring while on octreotide is provided in the related UpToDate content.
