Patient E
This patient was born at 35 weeks with a prenatally diagnosed congenital pleural effusion s/p pleural amniotic shunt. She required chest tube placement at birth and was started on sirolimus 0.8 mg/m2/day PO at one week of age due to persistent chylous effusion and inability to remove the chest tube. Initially chest output was low ranging from 0-3 ml/day, increased to maximum of 17 ml in a day and then decreased again to 0-5 ml/day. Chest tube was ultimately removed on day 15 (Fig 2). Subsequent sirolimus levels were therapeutic.