Perri A, Sbordone A, Fattore S, De Matteis A, Rotunno G, Marrocco GA, Nobile S, Giordano L, Tana M, Vento G. Neonatal chylothorax and ultrasound: Diagnosis, measurements, and correlations with management. World J Clin Pediatr 2026; 15(4): 117885 [DOI: 10.5409/wjcp.117885]
Corresponding Author of This Article
Stefano Nobile, MD, MSc, PhD, Adjunct Professor, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy. stefano.nobile@policlinicogemelli.it
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Pediatrics
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research-article
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Perri A, Sbordone A, Fattore S, De Matteis A, Rotunno G, Marrocco GA, Nobile S, Giordano L, Tana M, Vento G. Neonatal chylothorax and ultrasound: Diagnosis, measurements, and correlations with management. World J Clin Pediatr 2026; 15(4): 117885 [DOI: 10.5409/wjcp.117885]
World J Clin Pediatr. Dec 9, 2026; 15(4): 117885 Published online Dec 9, 2026. doi: 10.5409/wjcp.117885
Neonatal chylothorax and ultrasound: Diagnosis, measurements, and correlations with management
Alessandro Perri, Annamaria Sbordone, Simona Fattore, Alessia De Matteis, Giulia Rotunno, Giovanni A Marrocco, Stefano Nobile, Lucia Giordano, Milena Tana, Giovanni Vento
Alessandro Perri, Annamaria Sbordone, Simona Fattore, Alessia De Matteis, Giulia Rotunno, Giovanni A Marrocco, Stefano Nobile, Lucia Giordano, Milena Tana, Giovanni Vento, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Alessia De Matteis, Giulia Rotunno, Giovanni A Marrocco, Department of Woman and Child Health and Public Health, Catholic University of the Sacred Heart, Rome 00168, Italy
Giovanni Vento, Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Co-first authors: Alessandro Perri and Annamaria Sbordone.
Author contributions: Perri A, Sbordone A, and Vento G conceptualized the study; De Matteis A, Rotunno G, and Marrocco GA performed the formal data analysis and conducted the investigation; Perri A and Fattore S designed the methodology; Vento G supervised the study to completion; Perri A, Sbordone A, and Fattore S wrote the original draft of the manuscript; Nobile S, Giordano L, and Tana M reviewed and edited each successive version of the manuscript for important intellectual content; Perri A and Sbordone A share first authorship as they had equal roles in the study conceptualization and conduction, and thus qualify as the co-first authors; all authors read and approved the final version of the manuscript.
Institutional review board statement: The Institutional Review Board of Fondazione Policlinico Gemelli IRCCS provided approval for this study (No. 00008329/21).
Informed consent statement: Written informed consent was obtained from the parents of the patients.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Stefano Nobile, MD, MSc, PhD, Adjunct Professor, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy. stefano.nobile@policlinicogemelli.it
Received: December 18, 2025 Revised: January 30, 2026 Accepted: March 24, 2026 Published online: December 9, 2026 Processing time: 277 Days and 17.5 Hours
Abstract
BACKGROUND
Chylothorax is a rare condition in neonates. It is associated with increased mortality, prolonged hospital stay, and significant nutritional, metabolic, and immunological complications. We hypothesized that lung ultrasound may play a critical role in managing this condition. However, standardized ultrasound parameters for the management of chylothorax have not currently been identified.
AIM
To determine preliminary ultrasound measurement parameters for chylothorax in neonates and to assess their usefulness for future prospective studies.
METHODS
We retrospectively reviewed 10 cases of congenital chylothorax in neonates admitted to the neonatal intensive care unit at Fondazione Policlinico Universitario A. Gemelli. We collected the following standardized ultrasound measurements: Lung-chest wall distance, lung-diaphragm distance, and derived area. Finally, the correlation between these measurements was analyzed according to the primary outcome of the need for drainage.
RESULTS
The median gestational age of the study infants was 34.7 weeks. Five neonates required thoracentesis, and seven needed pleural drainage placement. Ultrasound evaluations were performed at birth and subsequently every 48 hours, or more frequently in cases of clinical instability. The receiver operating characteristic curves gave these values for the proposed measurements (setting the chest tube drainage as the outcome): Lung-chest wall distance [area under the curve (AUC) = 0.917; 95% confidence interval (CI): 0.810-1]; lung-diaphragm distance (AUC = 0.938; 95%CI: 0.869-1); derived area (AUC = 0.984; 95%CI: 0.954-1); cut-off values of 0.8 cm, 1.2 cm and 0.72 cm2 were identified for the lung-chest wall distance, lung-diaphragm distance, and derived area, respectively.
CONCLUSION
Lung ultrasound may be a valuable tool in the management of neonates with chylothorax. Future studies with a larger cohort are needed to confirm our findings.
Core Tip: Chylothorax is a rare but severe condition in neonates. Lung ultrasound can be useful in managing this condition, but ultrasound parameters have not been standardized thus far. The results of this study could be useful for proposing prospective studies intended to test “measurement protocol” for chylothorax in neonates. We retrospectively reviewed 10 cases of congenital chylothorax and measured the lung-chest wall distance, the lung-diaphragm distance, and the derived area. Receiver operating characteristic curves showed interesting values for the proposed measurements. Lung ultrasound, in the future, can be studied as a valuable tool in the management of neonates with chylothorax.
