Chylothorax in the neonate—A stepwise approach algorithm

Abstract

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.

Application of ultrasonography in neonatal lung disease: An updated review

“…Although it is a rare entity, congenital chylothorax is the most common reason for pleural effusion in neonates, and various treatment strategies have been introduced and implemented ( 146 , 147 ). It has been suggested that LUS should be considered for the diagnosis, monitoring, and follow-up of neonates with congenital chylothorax ( 147 , 148 ).…”

The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients

“…CL may lead to decreased blood volume, malnutrition, and a compromised immune system ( 16 ), severely affecting post-operative recovery, prolonging the length of stay (LOS), and even increasing mortality ( 17 , 18 ). Four main clinical treatments are available: medium-chain triglyceride diet (MCT diet) [with or without enteral nutrition (EN)] or low-fat diet, parenteral nutrition (PN), drug therapy (somatostatin such as octreotide), and surgery ( 4 , 19 – 21 ). However, there is no consensus on the optimal management of CL ( 22 ).…”

Management of Congenital Chylothorax of the Newborn

“…At the same time of publication of our systematic analysis of cases between 1990 and 2018, Rocha et al [ 6 ] published a comparable review including algorithms for both congenital and posttraumatic chylothorax. They state that in case of no response after 1 week of conservative treatment and drainage >10 mL/kg/day or persistent drainage of large volumes (>100 mL per day), for a period of 5 consecutive days or severe metabolic and nutritional complications, which are difficult to control, an invasive approach is recommended.…”