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Interestingly, thoracentesis fluid appeared \u2018milky\u2019 with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24\u2009mmol\/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.<\/jats:p>","DOI":"10.1136\/bcr-2021-245576","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T12:51:44Z","timestamp":1632919904000},"page":"e245576","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Milky pleural effusion in a neonate and approach to investigating chylothorax"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2329-6871","authenticated-orcid":false,"given":"Udara Dilrukshi","family":"Senarathne","sequence":"first","affiliation":[{"name":"Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka"},{"name":"Department of Chemical Pathology, Colombo North Teaching Hospital, Ragama, Sri 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