Management and outcomes of congenital chylothorax in the neonatal intensive care unit: A case series

Healy, Helen; Gipson, Kevin S.; Hay, Susanne; Bates, Sara V.; Kinane, T. Bernard

doi:10.1002/ped4.12007

Cited by 15 publications

(11 citation statements)

References 9 publications

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“…Prophylactic antibiotics can be considered, and immune globulins might be beneficial every 2 weeks in cases of prolonged fluid losses as are coagulation factors. A recent case series of 5 cases with confirmed CCT reported on the necessity of careful management of total body fluid balance and the successful replacement of chylous fluid losses with colloid infusions [192]. Chylous effusions usually last long; however, after 6 weeks, the majority of the effusions (74%) had ceased according to Buttiker et al [7].…”

Section: Discussionmentioning

confidence: 99%

Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018

2021

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Background: Congenital chylothorax (CCT) of the newborn is a rare entity but the most common cause of pleural effusion in this age-group. We aimed to find the optimal treatment strategy. Material and Methods: A PubMed search was performed according to the PRISMA criteria. All cases were analyzed according to prenatal, perinatal, and postnatal treatment modalities and follow-ups. Results: We identified 753 cases from 157 studies published between 1990 and 2018. The all-cause mortality rate was 28%. Prematurity was present in 71%, male gender dominated 57%, mean gestational age was 34 weeks, and birth weight was 2,654 g. Seventy-nine percent of newborns had bilateral CCT, the most common associated congenital anomalies with CCT were pulmonary lymphangiectasia and pulmonary hypoplasia, and the most common chromosomal aberrations were Down, Noonan, and Turner syndromes, respectively. Mechanical ventilation was reported in 381 cases for mean 17 (range 1–120) days; pleural punctuations and drainages were performed in 32% and 64%, respectively. Forty-four percent received total parenteral nutrition (TPN) for mean 21 days, 46% medium-chain triglyceride (MCT) diet for mean 37 days, 20% octreotide, and 3% somatostatin; chemical pleurodesis was performed in 116 cases, and surgery was reported in 48 cases with a success rate of 69%. In 462 cases (68%), complete restitution was reported; in 34 of 44 cases (77%), intrauterine intervention was carried out. Conclusion: Respiratory support, pleural drainages, TPN, and MCT diet as octreotide remain to be the cornerstones of CCT management. Pleurodesis with OK-432 done prenatally and povidone-iodine postnatally might be discussed for use in life-threatening CCT.

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Section: Discussionmentioning

confidence: 99%

Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018

2021

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“…[55], [64], [64], [66], [71], [73], [74], [78], [90]- [93]. TPN allows for a faster reduction in pleural effusion [83].…”

Section: Resultsmentioning

confidence: 99%

“…Treatment with somatostatin or octreotide has been implemented in more than half of the patients from the reviewed literature, in addition to dietary modifications (56,3%) and it achieved a desired therapeutic effect in 63.2 % of them. [2-3], [11][12], [17], [19][20], [25]- [28], [31]- [33], [37], [39], [41]- [43], [45], [52], [54]-[57], [62]- [64], [66], [70][71], [73], [77]- [80], [84], [86][87], [91][92], [95][96], [98], [103] Due to certain differences in pharmacokinetic properties and route of administration, octreotide is a more popular choice (79,9 % of patients) than somatostatin (10,4 %) [3], [11][12], [17], [19][20], [25]- [27], [31][32][33], [37], [39], [41]- [43], [45], [52],...…”

Section: Resultsmentioning

confidence: 99%

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop

Kochanowska

Piasecka

et al. 2022

J Educ Health Sport

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Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe. The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

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“…However, in some case series, the mortality and morbidity of the condition were much higher than this [ 3 , 4 ]. Helen H et al have published a case series of 5 neonates with CC in 2017 in which all babies had antenatally detected hydrops fetalis [ 5 ]. One baby died, and the length of hospital duration ranged from 53–144 days.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Congenital Chylethorax: A Successful Story of Medical Management

Kankananarachchi

Priyankara

Lakman

et al. 2021

Case Reports in Pediatrics

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Congenital chylothorax (CC) is one of the most common causes of pleural effusions in neonates. Associated ipsilateral pulmonary aplasia in CC results in neonatal respiratory distress. Here, we report 2 cases of CC who were managed in the Teaching Hospital Karapitiya, Sri Lanka, between 2017 and 2019. Both babies were males who presented with respiratory distress within a few hours of birth. Their antenatal ultrasound scans failed to detect CC. Chest radiographs showed left-sided pleural effusions. Pleural fluid was milky yellowish suggestive of chylothorax, and the analysis revealed elevated triglycerides, high lymphocyte counts, and low cholesterol levels compatible with CC. They were managed in the neonatal intensive care unit and kept nil by mouth for initial 48 hours. Intravenous octeotride infusion was started on day one and was continued for 7 and 10 days, respectively. The maximum dose of octeotride was 2 μg/kg/hour. Both babies needed intercostal tube placement for 5 and 6 days, respectively. None of them required invasive ventilation. They were started on a medium-chain fatty acid formula, which was continued for about one week. Both babies were commenced on breast milk by day 7 of life and continued with exclusive breastfeeding. Within two weeks, they were discharged home and followed up in the paediatric respiratory clinic for another year. None of them was found to have long-term respiratory complications during the follow-up.

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Management and outcomes of congenital chylothorax in the neonatal intensive care unit: A case series

Cited by 15 publications

References 9 publications

Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018

Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Two Cases of Congenital Chylethorax: A Successful Story of Medical Management

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