Chemical pleurodesis using povidon-iodine for chylothorax treatment in newborns

Abstract

Introduction. Chylothorax is a rare condition that results from abnormal accumulation of lymphatic fluid in the chest and one of the most common causes of pleural effusion in newborns. The aim of our study is to present our own experience of chemical pleurodesis using povidone-iodine in newborns with chylothorax.
 Materials and methods. In the present study, we studied data from 10 patients with chylothorax who, over the past years, starting in 2016, underwent chemical pleurodesis using the drug povidone-iodine. Congenital accumulation of lymph in the pleural cavity was recorded in 2 patients, acquired in 8 patients. The indications for this procedure were the absence of response to total parenteral nutrition for at least 10 days and the appointment of octreotide at the maximum dosage. Pleurodesis consisted in the introduction into the pleural cavity of a 4% solution of povidone-iodine with a calculated dose of 1 ml/kg. The povidone-iodine solution was kept inside the pleural cavity for the next 4 hours.
 Results. Chemical pleurodesis was successfully applied in all 10 patients. In 8 patients, a single prescription of the drug was sufficient, and in 2 remaining patients, the pleurodesis session was repeated. After the procedure of chemical pleurodesis, 2 patients developed respiratory distress syndrome caused by massive atelectasis of the homolateral lung, which was confirmed by X-ray examination. These patients required mechanical ventilation for 24 and 48 hours. The average time for the disappearance of chylothorax was 4 days. In the long-term follow-up, 1 patient died from progressive deterioration of pulmonary function against the background of lung hypoplasia.
 Conclusions. Our data demonstrate that povidone iodine pleurodesis is a effective treatment for chylothorax in newborns.