Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients

Muñiz, Gysella; Hidalgo-Campos, Jennifer; Valdivia-Tapia, Maria del Carmen; Shaikh, Nader; Carreazo, Nilton Yhuri

doi:10.1542/peds.2016-3309

Cited by 8 publications

(14 citation statements)

References 15 publications

(16 reference statements)

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“…Preoperative catheterization was performed in 9 patients in the effective group and 9 patients in the ineffective group. There was no significant difference in preoperative CVP between the two groups (effective group, 10 mmHg [5][6][7][8][9][10] versus ineffective group, 7 [7-10]; P ¼ 1.0). There was no significant difference in postoperative CVP between 7 patients in the effective group and 9 patients in the ineffective group (effective group, 14 mmHg [7][8][9][10][11][12][13][14][15] versus ineffective group, 14 [11.5-14]; P ¼ 1.0).…”

Section: Resultsmentioning

confidence: 94%

“…Medical therapy includes administration of steroids, 1 factor XIII concentrate, 5 octreotide, 6 or etilefrine. 7 , 8 Interventional therapy is indicated when conservative approaches of nutritional and medical therapy are unsuccessful. Interventional treatments, including thoracic duct ligation, lymphaticovenular anastomosis, and lymphangiography, 9 are so invasive and therefore not considered as first-line therapy.…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

Yakuwa

Miyaji

Kitamura

et al. 2021

JRSM Cardiovascular Disease

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Objectives Postoperative pleural effusion (PE) is common after pediatric cardiac surgery, and if prolonged can lead to the deterioration of the general condition due to malnutrition and result in death. This study aims at identifying the prognostic factors of prolonged PE after pediatric cardiac surgery. Design and settings: Patients were divided into the effective (with chest tube removal within 10 days after medical therapy) and ineffective (with chest tube in place for more than 10 days) groups. The factors were compared between the two groups retrospectively. Participants Participants included patients who had prolonged PE after cardiac surgery in national center for child and health development between October 2014 and October 2017. Main outcome measures Baseline characteristics and procedure details were compared between the two groups to determine the predictor of prolonged PE. White blood cell count, platelet count, neutrophil-to-lymphocyte ratio, hemoglobin level, serum total protein level, serum albumin level, blood fibrinogen level, serum creatinine level, etc. were examined. Results Twenty patients were included. Between the two groups, no significant differences in baseline characteristics, such as age, weight, and sex were found, and significant differences were observed only in the NLR change ratio (effective group, 5.1 [4.1–8.0] versus ineffective group, 11.9 [9.9–14.1]; P = 0.01). Conclusions NLR change ratio is a potential prognostic factor of prolonged PE, including chylothorax, after pediatric cardiac surgery.

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Section: Resultsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

Yakuwa

Miyaji

Kitamura

et al. 2021

JRSM Cardiovascular Disease

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“…Ohkura et al [7] reported that postoperative chylothorax in 2 adult patients following an esophagectomy was successfully treated with etilefrine and pleurodesis. Muniz et al [5] reported the resolution of a postoperative chylothorax in 2 pediatric patients with congenital esophageal atresia after etilefrine treatment. The therapeutic regimen in our case was identical to that in the latter report.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Etilefrine, a less well-known sympathomimetic agent, is also a pharmacological treatment option. Recent studies have reported its use in adult and pediatric patients with postoperative chylothorax [4, 5]. Herein, we report a case of a preterm neonate with congenital chylothorax who was successfully treated with etilefrine and pleurodesis.…”

Section: Introductionmentioning

confidence: 97%

Combination Therapy with Etilefrine and Pleurodesis for Refractory Congenital Chylothorax

et al. 2020

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Etilefrine, a sympathomimetic agent, is reportedly effective against postoperative chylothorax. However, its effectiveness in treating congenital chylothorax was unknown. We report herein a case of refractory congenital chylothorax treated with etilefrine in a late preterm neonate with massive fetal chylous pleural effusion. The chylothorax was unresponsive to previous treatments, including dietary and pharmacological treatment and thoracic duct ligation. The pleural effusion decreased after intravenous etilefrine was begun on day of life (DOL) 84 and resolved after the addition of chemical pleurodesis with OK-432 on DOL 90. This combination therapy may be a viable treatment option for cases of congenital chylothorax that are unresponsive to other treatments.

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“…Etilefrine , a sympathomimetic drug that causes contraction of smooth muscle fibers in the thoracic duct has been used, in combination with octreotide or not, in adult and neonatal patients with postoperative chylothorax 51–54 . Although experience with etilefrine is limited, it can be a novel option in the conservative treatment of neonatal chylothorax.…”

Section: Methodsmentioning

confidence: 99%

Chylothorax in the neonate—A stepwise approach algorithm

Rocha

Arnet

Soares

et al. 2021

Pediatric Pulmonology

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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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Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients

Cited by 8 publications

References 15 publications

Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

Combination Therapy with Etilefrine and Pleurodesis for Refractory Congenital Chylothorax

Chylothorax in the neonate—A stepwise approach algorithm

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