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.