Neonatal pericardial effusion: case report and review of the literature

Pericardial effusion (PCE) is a rare condition in neonates. The most common cause is iatrogenic due to central venous catheters (CVCs) and symptoms vary from asymptomatic to more severe presentations, such as cardiac tamponade. Treatment of this condition in neonates remains controversial. The authors present a case report of a preterm neonate with a PCE and a review of the literature. A preterm infant was born at 26 weeks of gestation and with a birth weight of 690 grams. A peripherally inserted central catheter (PICC) was inserted on day 4, which was uneventful. Due to a hemodynamically significant patent ductus arteriosus with no response to two cycles of treatment with ibuprofen, she was submitted to surgical ligation on day 38. In the postoperative echocardiogram, the tip of the PICC was seen in the right ventricle and the catheter was retracted. An echocardiogram was performed on day 55, showing a PCE with a slight diastolic compromise of the right atrium. The catheter was withdrawn and diuretic therapy with furosemide was initiated. PCE presented a gradual reduction until complete resolution within 3 weeks. A review of the literature about postnatal PCE was performed. A final sample of 34 articles was included. The main PCE causes were iatrogenic (due to CVCs, and postoperative of major cardiac surgery) and infection. Management of this condition was variable between cases ranging from clinical surveillance in asymptomatic newborns with small effusions to pericardiocentesis in large effusions with signs of hemodynamic instability. In conclusion, PCE is a condition that is often underdiagnosed in neonates. The most common cause, as occurred in the case presented above, is a mispositioned CVC. Management of this condition is still controversial and further studies are needed to establish therapeutic protocols in neonates.