Non-Chylous Congenital Pleural Effusion in New-Born

for which she was admitted to the neonatal intensive care unit. She was observed with dysmorphic features in the form of upward slanting eyes, short neck, sandal gap de-formity sign [Figure 1], but there was no signs of hydrops fetalis. Rest of the systemic examination was normal. The blood gas analysis revealed severe mixed acidosis with pH 6.8, PaO2 90 mmHg, and PaCO2 113 mmHg, HCO3 and BE were un-recordable. The baby was connected to conventional mechanical ventilation; IV fluids and antibiotics were charted but there was progressive worsening with increasing Fio2 requirements up to 100%. An urgent bedside chest X - ray was done revealed left side pleural effusion with mediastinal shift of the airway and heart to the right side [Figure 2]. Echo-cardiography was done and showed large sized patent ductus arteriosus with severe persistent pulmonary hypertension. Chest tube was inserted which drained straw - coloured fluid around 100 ml.