180 JE Kim, et al. • Pleurodesis with OK-432 treatment of persistent congenital chylothorax which is resistant to octreotide infusion as second line therapeutic option. Long­lasting chyle drainage could put patients at increased risk for malnutrition, nosocomial infections, and fluid and electrolyte imbalances1,18). Ergaz et al.3) reported that two of 11 neonates died after resolution of chylothorax from deteriorating renal failure and a high rate of nosocomial infections that occurred in six out of 11 neonates with congenital chylothorax. Therefore, based on our first case experience, we decided to apply pleurodesis earlier for the second case. As a result, earlier removal of the chest tube was possible and the duration of hospitalization was reduced without any complications. Few complications related to OK­432 have been reported in adults, with the exception of signs of inflammatory reactions such as fever, pain, and local erythema. There have been no adverse effects of fetal therapy with OK­432, with the exception of one report of transient fetal tachycardia8,9). However, Cowie et al.19) recently described that intrapleural infusion of OK­432 was associated with transient suppression of fetal electroencephalographic activity, breathing and body movements in fetal sheep. In addition, Bennet et al.20) reported that a single injection of OK­432 can be associated with a risk of focal cerebral injury in the preterm fetus. Since the case numbers for treatment with OK­432 are small and limited, a prospective randomized study in newborns will be required to prove its effectiveness, and ascertain side effects and safety of use. Long term postnatal follow­up of neonates treated with OK­432 is also needed. In conclusion, we report that intrapleural injection of OK­432 was successful in two preterm infants with persistent chylothorax that was refractory to conservative treatment. If used appropriately, this option has the potential to reduce the morbidity related to prolonged pleural effusion and hospital stay, as well as early removal of the chest tube and a reduction in surgical intervention. In addition, this treatment involves simple and minimally invasive drug delivery with a chest tube in place, and can be carried out as a bedside procedure without the requirement of anesthesia. References 1. Al­Tawil K, Ahmed G, Al­Hathal M, Al­Jarallah Y, Campbell N. Congenital chylothorax. Am J Perinatol 2000;17:121­6. 2. Caserio S, Gallego C, Martin P, Moral MT, Pallas CR, Galindo A. Congenital chylothorax: from foetal life to adolescence. Acta Paediatr 2010;99:1571­7. 3. Ergaz Z, Bar­Oz B, Yatsiv I, Arad I. Congenital chylothorax: clinical course and prognostic significance. Pediatr Pulmonol 2009;44:806­11. 4. Cleveland K, Zook D, Harvey K, Woods RK. Massive chylothorax in small babies. J Pediatr Surg 2009;44:546­50. 5. Katanyuwong P, Dearani J, Driscoll D. 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