Bilateral Congenital Chylothorax With Neonatal Ventilator-Associated Pneumonia and Sepsis: Diagnostic and Therapeutic Challenges: A Case Report.

BACKGROUND Congenital chylothorax is a rare condition characterized by the accumulation of lymph in the pleural space. It is the most common cause of neonatal pleural effusion, with low incidence and male predominance. When it is complicated by other conditions, diagnosis and management become challenging. This report aims to present a rare case of bilateral congenital chylothorax with a complicated clinical course, highlighting the associated diagnostic and management challenges. CASE REPORT We report a male Kosovar neonate presenting on the third day of life with respiratory distress requiring intubation and mechanical ventilation. Imaging revealed bilateral pleural effusions. The first pleural fluid sample obtained on day of life 12 was non-diagnostic. A second analysis showed elevated triglycerides, a triglyceride-to-cholesterol ratio greater than 1.52, milky appearance, and lymphocyte predominance (>80%), confirming congenital chylothorax. Recurrence after breastfeeding further supported the diagnosis. Management included thoracic drainage, continuous octreotide infusion (up to 4 mcg/kg/h for 25 days), and a medium-chain triglyceride-based formula. The course was complicated by ventilator-associated pneumonia and neonatal sepsis, both treated according to standard protocols. The neonate required mechanical ventilation for 20 days. After 56 days of hospitalization, the patient was discharged in good clinical condition with minimal but progressive weight gain (255 g). CONCLUSIONS Bilateral congenital chylothorax, although rare and potentially life-threatening when complicated by ventilator-associated pneumonia and neonatal sepsis, can be successfully managed with timely diagnosis and individualized conservative treatment within a multidisciplinary setting.