An Unusual Manifestation of Non-immune HydropsFetalis

• A 22-year-old mother with non-immune hydropsfetalis (excessive fluid collection in the fetus not caused by incompatible maternal and fetal blood types) delivered by C section at 35 weeks of gestation.
• The baby did not cry at birth and required emergency needle aspiration of fluid from the left pleural effusion (fluid between the tissues that line the lung and chest).
• Work-up was done for the cause of NIHF like infections (parvo virus and TORCH) and genetic abnormalities, both of which were negative.
• There was a gradual reaccumulation of left pleural fluid on day 6 which became milky after starting feeds and had to be drained by an intercostal drainage.
• Diagnosis of chylothorax, which is an accumulation of chyle in the pleural space as a result of damage to the thoracic duct was made. It was confirmed by increased triglyceride levels and lymphocytes.
• Chyle is a milky fluid enriched with fat formed in the small intestine during digestion of fatty foods and drained into thoracic duct by the lymphatic channels.
• Simyl MCT feeds was started as it contains medium chain triglycerides which bypass lymphatic drainage for absorption, thereby reducing the flow of chyle through the thoracic duct and helping in spontaneous healing.
• Pleural effusion resolved and the baby was discharged on simyl MCT feeds after 25 days of NICU stay.
• NIHF due to Chylothorax has the worst outcome. But this neonate completely recovered with medical management alone.