Background
Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates.
Methods
An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax.
Discussion and Conclusion
The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.
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Some studies have shown an association between osteogenesis imperfecta and congenital heart diseases, but only those involving changes in the connective tissue of heart structures, such as heart valves, chordae tendineae, fibrous rings, ventricular septum and aortic root (dilatation). The concomitant presence of osteogenesis imperfecta and aortopulmonary window has not been reported in the specialized literature, rendering the present case report uncommon. We report the case of a male infant aged 2 months and 15 days, diagnosed with type I osteogenesis imperfecta and type I aortopulmonary window, submitted to surgery to completely repair his heart disease. In addition, we provide a literature review and discuss the clinical and surgical approaches to this infant, emphasizing that previous multidisciplinary planning is essential for a successful outcome.
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