Chylothorax is the accumulation of lymphatic fluid in the pleural space that usually occurs after injury to the thoracic duct (surgery or trauma) or in association with various medical conditions including neoplasm, lymphatic or a congenital abnormality .
Conservative treatment includes keeping the child starved, or giving enteral medium chain triglycerides with or without intravenous alimentation. This treatment had failed in our baby. Initial misdiagnosis (as a leak) resulted in a delay of about 2 weeks in instituting aggressive conservative management of chylothorax. During this period the baby had lost weight. Components of usual surgical treatment are: treatment of the underlying cause, decreasing chyle production, draining and obliterating the pleural space, suture closure of thoracic duct or application of sealing agents, providing appropriate fluid and nutritional replacement, and instituting necessary respiratory care.
Surgical therapy is reserved for cases with persistent and/or high volume lymph leak that does not resolve within 4 weeks of conservative management. Various surgical procedures have been described including direct ligation of the thoracic duct [2, 3] pleurodesis with different agents including application of fibrin glue to putative sites of leaks  and placement of a pleuro-peritoneal shunt [5, 6]. Congenital chylothorax has been reported to be successfully treated by the application of fibrin glue .
Among all surgical options, application of fibrin glue appears to be an attractive approach in high risk cases like neonates. It is quick, safe, effective and easy for the novice. Its efficacy has been shown in postoperative chylothorax cases. Nguyen and Tchervenkov in 1994 have reported successful application of fibrin glue in a 600 gram premature neonate . There are few reports in English literature on the use of fibrin glue for chylothorax in neonates as a complication of esophageal atresia repair. Rifai et al in 2003 successfully treated chylothorax in a post surgical case of esophageal atresia by a combination of argon beam coagulation of the mediastinum and fibrin glue application .
High index of suspicion is necessary for diagnosing chylothorax in postoperative effusions developing after thoracic surgeries. The diagnosis may be confused with anastomotic leak in EA/TEF. Prompt treatment should be initiated with conservative methods however application of topical fibrin glue seems a safe and easy approach.