Use of octeriotide in the management of neonatal Chylothorax secondary to repair of congenital diaphragmatic hernia: A report of two cases and review of literature

Abstract

Chylothorax, a known complication of surgery for Congenital Diaphragmatic hernia, can sometimes be resistant to treat. Octeriotide (Somatostatin analogue) can be useful in this situation. However, the dose and schedule of Octeriotide therapy in neonates is not well established. We report two cases of resistant chylothorax following surgery for congenital diaphragmatic hernia which were successfully managed by using an escalating infusion of octeriotide. The literature on the subject is also reviewed.

Octreotide Use in Neonates: A Case Series

“…In a study conducted by Aljazairi et al, the duration of administration of octreotide ranged from 5 to 15 days [ 5 ]. Similar results have been reported in other studies where the duration of octreotide therapy in cases of successful resolution varied between 5 and 25 days [ 2 , 10 , 16 , 17 ]. Thus, octreotide therapy has been reported to result in faster resolution of chylous effusion as compared with only conventional therapy.…”

“…In our cases with successful resolution, the chylous effusion resolved within 3–16 days of reaching the maximum dose of octreotide infusion. Similar results were seen in the studies done by Jarir et al and Paget-Brown et al where the chylous effusion resolved between 2 and 8 days of reaching the maximum dose of octreotide infusion [ 17 , 18 ].…”

“…As a continuous infusion, octreotide was started at a rate of 1 µg/kg/h, which was gradually increased by 1 µg/kg daily depending upon the response till a maximum dose of 10 µg/kg/h was reached. This is similar to most studies where the treatment was started with a lower dose and progressively increased, but the dose to elicit a significant reduction in chylous effusion was quite variable [ 2 , 5 , 10 , 16 , 17 ]. The maximum dose required for successful resolution in our study was 4–10 µg/kg/h with a median of 8 µg/kg/h.…”

“…The median time of initiation of octreotide therapy after diagnosis of chylous effusion was 16 days (4–27 days). Goyal et al and Jarir et al started octreotide therapy on the ninth and the tenth day of the chylous effusion, respectively [ 16 , 17 ]. Moreira-Pinto et al started octreotide on the second day of chylous effusion resulting in faster resolution [ 10 ].…”

“…We abruptly ceased octreotide infusion within 48 h of successful resolution of chylous effusion without any recurrence. On the contrary, Jarir et al and Shah and Sinn carried out a gradual weaning of the octreotide infusion over 3–5 days after resolution of the chylous effusion [ 2 , 17 ]. In both studies, there were no side effects or recurrence of chylous effusion reported.…”