OK-432 (
picibanil) is an inactivated preparation of Streptococcus pyogenes that causes
pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of
OK-432 has recently been used to successfully treat neonatal and fetal
chylothorax. Here we report a trial of intrapleural instillation of
OK-432 in two preterm infants who were born with
hydrops fetalis and massive bilateral
pleural effusion. Both cases showed persistent
pleural effusion, refractory to
conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with
OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of
pleural effusion and progressed into
hydrops. Within two to three days after
OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to
OK-432 injection. We suggest that
OK-432 should be considered as a therapeutic option in infants who have persistent
pleural effusion for more than four weeks, with the expectation of the early removal of the
chest tube and a good outcome.