A primi mother was referred to authors’ centre at 33 wk gestation for assessment of polyhydramnios. Her blood pressure and previous investigations including ultrasonography (USG) were normal. USG at admission revealed gestation of 33 wk, bilateral fetal pleural effusions and polyhydramnios. Her blood group was B positive. VDRL test was nonreactive. She tested negative for HIV, HBsAg and tuberculosis. Vaginal swab did not grow any microorganism. Fetal echocardiography was normal. She underwent spontaneous vaginal delivery within a couple of days.
At birth, neonate was limp, apneic and cyanosed with heart rate of 100/min. He was immediately intubated and positive pressure ventilation initiated. He was then transferred to intensive care unit and put on ventilator (required MAP of 15.8 and FiO2 0.8 for stabilization). His weight was 2.5 kg, length, 46 cm; and head circumference, 34 cm. Chest movements and air entry were decreased on both sides. The cardiac apex and heart sounds were normal with no murmur. There was no facial dysphormology, skin or scalp edema, hepatosplenomegaly or ascites.
Emergency chest x-ray(CXR) revealed hazy lung fields on both sides with obscured costophrenic (CP) angles, suggestive of pleural effusions with passive collapse of the underlying lung (Fig. 1a). Arterial blood gas showed pH of 7.11, pCO2 of 73 mmHg, pO2 of 66 mmHg (FiO2, 0.8), SaO2 of 85% and HCO3 of 22 mmol/L. Immediate percutaneous intercostal drainage yielded 70 ml of yellowish fluid on the right side and 54 ml on the left (Fig. 1b). The blood gas was normalised by next 2 h. Repeat CXR at 24 h showed normal lung fields, CP angles and hemidiaphragms (Fig. 2).
His blood group was B positive. CBC revealed PCV of 42.3, total leucocytes of 23,100/mm3 with 51% neutrophils, 46% lymphocytes and 3% eosinophils, platelets of 2,58,000/mm3 and ESR of 0/1st h. Direct Coomb’s test and TORCH titres were negative. Karyotyping was normal. DNA PCR test for parvovirus was negative. Pleural fluid analysis showed cells of 19,200/mm3 with 100% lymphocytes, no bacteria or pus cells on gram stain, albumin of 2.0 g/dL (serum albumin, 2.5 g/dL), LDH of 110 IU/L and glucose of 104 mg/dL. Pleural fluid culture remained sterile. Triglyceride estimations were not done.
Neonate was weaned to room air by day 3 and extubated. Subsequently, he was started on breastfeeds and discharged by day 12. His neurosonogram, abdominal ultrasonography and echocardiography were normal. He remained asymptomatic and had normal examination at 1 month. He has been followed up regularly. His development was normal at 1 year of age with length and weight of 76 cm and 10 kg respectively.