Congenital chylothorax: a case report

Brito, Teresa; Oliveira, Clariana Alves Majado de; Sousa, Lídia; Barbosa, Ana Raquel; Pinho, O.; Mesquita, M. M.; Pinto, Rui; Inocencio, Athaluama Pires da Silva; Valente, Francisco

doi:10.1002/uog.17

Cited by 17 publications

(20 citation statements)

References 2 publications

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“…In the neonatal period, persistent hydrothorax may require invasive intervention such as thoracentesis (sometimes yet in the delivery room, even followed by paracentesis if ascitis is associated) and cardiorespiratory resuscitation [22][23][24][25]. In case of reaccumulation of pleural fluid, a chest tube drainage is put in place to allow lung expansion [22].…”

Section: Introductionmentioning

confidence: 99%

Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome

Bianchi

Lista

Castoldi

et al. 2010

The Journal of Maternal-Fetal & Neonatal Medicine

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Section: Introductionmentioning

confidence: 99%

Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome

Bianchi

Lista

Castoldi

et al. 2010

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Congenital chylothorax occurs in 1 in every 12,000-15,000 pregnancies despite it being the most common form of pleural effusion encountered in the perinatal period [15,16] . It is associated with fetal pulmonary hypoplasia especially if developed in the second trimester as a result of impaired lung growth by compression.…”

Section: Fetal Chylothoraxmentioning

confidence: 99%

“…A reporting bias may exist. A 10% spontaneous resolution rate was observed in studying the natural history of fetal chylothorax without treatment [9,[16][17] . Therefore whether the success reported before was indeed the sole effect of fetal pleurodesis with OK-432, although we believe so, is still an open question.…”

Section: Factors Affecting the Outcomes In Our Patientsmentioning

confidence: 99%

Antenatal Treatment of Chylothorax and Cystic Hygroma with OK-432 in Nonimmune Hydrops fetalis

Chen

Chen²,

Shih³

et al. 2005

Fetal Diagn Ther

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Objectives: To present our experience of using OK-432 in treating fetal cystic hygroma and chylothorax complicated with nonimmune hydrops fetalis. Methods: OK-432 (Picibanil^®) was injected into the fetal pleural cavity or fetal cystic hygroma. Results:Patient 1: A 23-year-old, gravida 2, para 1, was found to have a recurrent fetal chylothorax at GA 29 weeks. Serial amnioreduction and thoracocentesis was performed at GA 31, 32, 33, and 34 weeks. Intrapleural OK-432 injection was performed twice at GA 33 and 34 weeks. Cyanosis and respiratory distress were noted immediately after birth (GA 34 weeks). The baby expired despite of aggressive neonatal resuscitation. Patient 2: A 26-year-old, gravida 2, para 1, was found to have a cystic hygroma of her fetus at GA 17 weeks. Karyotype of the cystic fluid and the amniocytes were 46, XY. Fetal ascites developed at GA 22 weeks. OK-432 injection into the tumour was performed at GA 23 weeks. Stabilization of the cystic hygroma was noted throughout the pregnancy (about 3.5 cm in diameter). Serial fetal paracentesis and/or amnioreduction were performed. Karyotype of the ascites was again 46, XY. Maternal dietary modification with medium chain triglyceride was also prescribed. Chylothorax developed and the baby was born by cesareans at GA 32 weeks. Resolution of pleural effusion, ascites, and regression of cystic hygroma were noted since the 2nd day after birth. The baby had survived beyond 4 months of age at submission. Conclusion: Combination of antenatal OK-432 injection, maternal dietary modification, serial thoracocentesis plus paracentesis, together with amnioreduction and tocolysis, appeared to contribute to the success of antenatal treatment. Fetal pulmonary expansion may determine the immediate neonatal survival.

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“…However, this method causes a prolongation in the duration of pleural drainage, mechanical ventilation, and total parenteral nutrition. Meanwhile, the method leads to loss of lymphocytes, proteins, coagulation factors, and antibodies as well as lymphatic fluid, and causes an increase in the occurrence of complications like hypoproteinemia, coagulopathy, lymphopenia, hypogammaglobulinemia, sepsis, and ventilator-related pulmonary injury 9 . In the case of continuation of drainage despite 2 to 5 weeks of total parenteral nutrition, it is advocated to perform surgery-like ligation of the thoracic ductus, pleuroperitoneal shunt, pleurectomy, or pleurosis.…”

Section: Discussionmentioning

confidence: 99%