Successful use of doxycycline pleurodesis in non-immune hydrops fetalis secondary to congenital chylothorax

Congenital chylothorax is a rare presentation of nonimmune hydrops fetalis (NIHF). We report a case of congenital chylothorax presenting as NIHF managed successfully with chemical pleurodesis. A term male infant presented at birth with anasarca and respiratory failure secondary to bilateral pleural effusions. The infant was initially managed with ventilation and tube thoracocentesis however re-accumulation of pleural fluid occurred when feeds were started. Pleural fluid analysis was consistent with congenital chylothorax. Pleural fluid re-accumulated despite conservative management with tube thoracocentesis, nutritional interventions and octreotide therapy but responded to chemical pleurodesis with doxycycline. To our knowledge, this is the first case of congenital chylothorax treated successfully with chemical pleurodesis utilizing doxycycline as the sclerosing agent. This case adds to the literature by providing support for doxycycline as an alternative agent for chemical pleurodesis in the management of congenital chylothorax.