title: Pleural effusions in the neonate.
abstract: BACKGROUND
  Pleural effusions are rare in the neonate and may be associated to several clinical conditions. Only a few series of pleural effusions in the fetus and newborn are described in the literature.
  
  
  OBJECTIVE
  This study was undertaken to determine more accurately the causes and prognostic significance of pleural effusions in a population of high-risk neonates.
  
  
  METHODS
  A retrospective chart review of 62 neonates admitted to the neonatal intensive care unit of six medical centers in the north of Portugal, between 1997 and 2004, that presented the diagnosis of pleural effusion.
  
  
  RESULTS
  33M/29F newborns; preterms 47 (76%); GA 33 (25-40) wk; BW 1830 (660-4270) g; C-section 39 (63%). Pleural effusions were congenital in 20 (32%) newborns and acquired in 42 (68%). Congenital pleural effusions occurred as fetal hydrops in 11 (18%) patients and as chylothorax in 9 (15%). In four cases of hydrops, the cause was a congenital chylothorax. Congenital chylothorax (n=13) was the most common (65%) congenital pleural effusion in this study. The incidence of congenital chylothorax was 1:8.600 deliveries and male:female ratio was 2:1. Mortality occurred in five newborns due to pulmonary hypoplasia. Traumatic (iatrogenic) were the most frequent (n=31) acquired pleural effusions. These included 8 (13%) cases of hemothorax and 8 (13%) cases of total parenteral nutrition leakage. Pleural effusions after intra-thoracic surgery were mainly (79%) chylothoraces. There were 11 (26%) non-iatrogenic acquired pleural effusions. No mortality was associated with acquired pleural effusions.
  
  
  CONCLUSIONS
  Congenital pleural effusions usually occur as hydrops or congenital chylothorax. Traumatic (iatrogenic) are the most frequent acquired pleural effusions in a tertiary NICU. Pleural effusions after intra-thoracic surgery are mainly chylothoraces. Non-iatrogenic acquired pleural effusions are associated to several clinical conditions, and mortality is usually associated to the underlying condition.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Hospital de São João, University Hospital, Porto, Portugal. gusrocha@oninet.pt
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rocha
authors.forename: Paula
authors.initials: P
authors.lastname: Fernandes
authors.forename: Paula
authors.initials: P
authors.lastname: Rocha
authors.forename: Conceição
authors.initials: C
authors.lastname: Quintas
authors.forename: Teresa
authors.initials: T
authors.lastname: Martins
authors.forename: Elisa
authors.initials: E
authors.lastname: Proença
mesh_terms: D004487:Edema / Q000453:epidemiology; D005260:Female; D007839:Functional Laterality; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D018579:Patient Selection; D010996:Pleural Effusion / Q000150:complications / Q000453:epidemiology*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies