Patient G
Patient G was born emergently at 35 weeks due to decreased fetal
movements and fetal hydrops, and found to have bilateral pleural
effusions at birth requiring chest tube placements. The vascular team
was involved on day 3 of life due to significant ongoing chest tube
output concerning for lymphatic malformation. He was started on
sirolimus at a dose of 0.4 mg/m2/day via NGT. Had some interruptions to
sirolimus in the beginning, due to intermittent discontinuation in the
setting of infectious concern- necrotizing enterocolitis (NEC). Hence,
initially the chest tube output was high and ranged 60-260 ml/day.
However, by day 13 sirolimus trough was therapeutic and chest tube
output was noted to come down with eventual removal of chest tube on day
23 (Fig 2). Patient was ultimately taken off sirolimus two weeks post
chest tube removal due to concern for another infection. He did not
develop any subsequent effusions.