Rocha Gustavo
Division of Neonatology, Department of Paediatrics, São João Hospital, Porto, Portugal.
Curr Opin Pulm Med. 2007 Jul;13(4):305-11. doi: 10.1097/MCP.0b013e3281214459.
This review highlights the pathophysiological mechanisms, incidence, clinical features, as well as the diagnosis and treatment of pleural effusions in the neonate.
Pleural effusions are rare except in hydropic neonates. Elevated pleural fluid/serum immunoglobulin G ratio may be a diagnostic marker for congenital chylothorax in utero. Chylothorax may be congenital or acquired. Hydrothoraces may appear at any time during the neonatal period and are related to infectious and noninfectious aetiologies. Haemothorax is defined as the presence of blood in the pleural space. Parenteral nutrition leakage may occur in a newborn with a venous central catheter leading to an effusion that looks like a chylothorax. The value of elevated pleural fluid N-terminal pro-brain natriuretic peptide levels as a marker of congestive heart failure is not yet established in neonates. More recently, in cases of chylothorax that did not resolve with drainage and bowel rest, the use of somatostatin or its analogue octreotide has been described with success. If conservative management fails after 5 weeks, surgical intervention is indicated.
Clinicians must be aware of the wide range of disorders causing pleural effusions, the different types and clinical presentations, differential diagnosis, and how to treat each specific case.
本综述重点介绍新生儿胸腔积液的病理生理机制、发病率、临床特征以及诊断和治疗方法。
胸腔积液在新生儿中较为罕见，除非是水肿胎儿。胸腔积液/血清免疫球蛋白G比值升高可能是宫内先天性乳糜胸的诊断标志物。乳糜胸可分为先天性或后天性。胸腔积液可在新生儿期的任何时候出现，与感染性和非感染性病因有关。血胸定义为胸腔内有血液。静脉中心导管置入的新生儿可能发生肠外营养渗漏，导致类似乳糜胸的胸腔积液。胸腔积液N端脑钠肽前体水平升高作为新生儿充血性心力衰竭标志物的价值尚未确定。最近，对于经引流和肠道休息后仍未缓解的乳糜胸病例，已成功应用生长抑素或其类似物奥曲肽进行治疗。若保守治疗5周后失败，则需进行手术干预。
临床医生必须了解导致胸腔积液的各种疾病、不同类型和临床表现、鉴别诊断以及如何治疗每一个具体病例。
