Il chilo vien mangiando

Neonatal pleural effusion is a rare but potentially severe condition, with chylothorax being its leading cause. This report describes the case of a newborn with an isolated right congenital pleural effusion, initially detected via prenatal ultrasound. Due to the onset of respiratory distress at birth, the infant required CPAP ventilation and an urgent, ultrasound-guided thoracentesis. Analysis of the pleural fluid before feeding showed a triglyceride level of 35 mg/dl; however, following the initiation of enteral nutrition, a second thoracentesis revealed a sharp increase in triglycerides (424 mg/dl), confirming the diagnosis of chylothorax. The newborn was successfully managed conservatively by using a specialised formula rich in medium-chain triglycerides (MCT). Complete resolution of the effusion was achieved by day 26 of life, allowing for the gradual and safe reintroduction of expressed breast milk. This case highlights that targeted nutritional therapy combined with close ultrasound monitoring provides an effective management strategy and prevents the need for more invasive surgical interventions.