Etiology, clinical manifestations, diagnosis and evaluation of pleural effusions in the neonate
- Joseph B Philips III, MD, FAAP
Joseph B Philips III, MD, FAAP
- Professor of Pediatrics
- University of Alabama at Birmingham
Although pleural effusions in neonates are rare, it is important to identify the underlying cause, as it guides management decisions and helps to predict the chronicity of the course and duration of care.
The etiology, clinical manifestations, and evaluation of neonatal pleural effusions will be reviewed here. The management of neonatal pleural effusions is discussed separately. (See "Management of pleural effusions in the neonate".)
ANATOMY AND PHYSIOLOGY OF THE PLEURAL SPACE AND FLUID
The pleural space is bounded by the visceral and parietal pleura mesothelial membranes that line the chest wall and lung surface (image 1). The volume of fluid in the pleural space results from a balance of fluid production thought to be made by the visceral pleura, and absorption by the lymphatics of the parietal pleura. A pleural effusion occurs as fluid collects in the pleural space when the production of pleural fluid is in excess of absorption. This can result from overproduction of fluid and/or reduced absorption, depending on the underlying etiology. Pleural anatomy, fluid balance, and accumulation based on data in older patients are discussed separately. Little is known about the dynamics of pleural fluid production and reabsorption in the newborn. (See "Mechanisms of pleural liquid turnover in the normal state" and "Mechanisms of pleural liquid accumulation in disease".)
Data are limited on the incidence of neonatal pleural effusions. A study of neonates admitted to six Portuguese neonatal intensive care units (NICUs) from 1997 to 2004 reported 62 cases of pleural effusions out of 112,000 deliveries resulting in an estimated incidence of 0.06 percent . In an older case series from a single center, pleural effusions were noted in 33 out of 1482 infants admitted to the NICU (2.2 percent) .
DISORDERS ASSOCIATED WITH PLEURAL EFFUSIONS
Numerous disorders have been associated with neonatal pleural effusions. These conditions can be categorized as congenital (fetal) or acquired disorders. In the previously mentioned Portuguese case series, pleural effusions were due to congenital conditions in approximately one-third of the patients (n = 20) (32 percent) and were acquired in the remaining two-thirds (n = 42) .
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- ANATOMY AND PHYSIOLOGY OF THE PLEURAL SPACE AND FLUID
- DISORDERS ASSOCIATED WITH PLEURAL EFFUSIONS
- - Hydrops fetalis
- - Congenital chylothorax
- - Congenital heart disease/vascular malformations
- - Pulmonary malformations
- - Infection
- - Other causes
- - Traumatic chylothorax
- - Catheter-related etiologies
- - Hemothorax
- - Other causes
- CLINICAL MANIFESTATIONS
- - Congenital
- - Acquired
- Clinical findings
- FURTHER DIAGNOSTIC EVALUATION
- - Transudate
- - Exudate
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS