Prolonged Octreotide Therapy in a Neonate with Recurrent Congenital Chylothorax

Background: Congenital chylothorax (CC) is the most common cause of pleural effusion in neonates. While octreotide is a known therapy for this condition, refractory cases usually require high doses of the drug or surgical intervention. The use of prolonged use of octreotide, extending to the outpatient settings is limited. Clinical Description: A term female neonate, with antenatal scan of bilateral lung hypoplasia with leftward mediastinal shift, was born with hydrops and birth asphyxia, followed by respiratory distress. Management and Outcome: Chest imaging revealed massive right-sided pleural effusion. Biochemical analysis confirmed chylous effusion. Initially stabilized with mechanical ventilation and pleural drainage, the clinical course, however, was complicated by coagulopathy and sepsis. Despite transient improvement with total parenteral nutrition, followed by oral feeding with medium-chain triglyceride-rich formula, and octreotide, there was repeated re-accumulation of chyle requiring repeated intercostal drain placement. Ultimately, the neonate was maintained on long-term octreotide therapy, even beyond discharge, under regular follow-up monitoring. The infant showed gradual resolution of effusion, stable respiratory status, and normal development at 5 months, with no adverse effects of octreotide. Conclusion: This case demonstrates the feasibility and safety of extended octreotide therapy in managing recurrent CC.