Subscribe to RSS
DOI: 10.1055/s-2000-9281
CONGENITAL CHYLOTHORAX
Publication History
Publication Date:
31 December 2000 (online)
![](https://www.thieme-connect.de/media/ajp/200003/lookinside/thumbnails/10.1055-s-2000-9281-1.jpg)
ABSTRACT
The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for ≤ 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for ≤ 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.
KEYWORD
Congenital chylothorax - medium chain triglycerides rich formula - total parenteral nutrition - bronchopulmonary dysplasia - hydrops fetalis
REFERENCES
- 1 Van Aerde J, Campbell A N, Smyth J A, Lloyd D, Bryan M H. Spontaneous chylothorax in newborns. AJDC . 1984; 138 961-964
- 2 Essa D, Balaraman V, Ash K, Thompson B, Boychuk R. Congenital chylothorax and mediastinal neuroblastoma. J Pediatr Surg . 1991; 26 96-98
- 3 Mc Williams B, Fan L, Murphy S. Transient T-cell depression in postoperative chylothorax. J Pediatr . 1981; 99 595-597
- 4 Booth R F, Nicolaides K H, Greebough A, Gamsu H R. Pleuroamniotic shunting for fetal Chylothorax. Early Hum Dev . 1987; 15 365-367
- 5 Ozkan H, Ay N, Ozkasoy D, Ercal D, Erata Y, Dutak H. Congenital chylothorax. Turk J Pediatr . 1996; 38 113-117
- 6 Johnstone W A, Feins H R. Chylothorax. Chest Surg Clin North Am . 1994; 4 617-628
- 7 Machin G A. Hydrops revisited: literature review of 1,414 cases published in the 1980's. Am J Med Gen . 1989; 34 368-390
- 8 Pisek G. Report of a chylothorax. Arch Pediatr . 1917; 34 929-937
- 9 Sasson C S, Light R W. Chylothorax and pseudo-chylothorax review. Crit Care Med . 1985; 6 163-171
- 10 Teba L, Dedhia H V, Bowen R, Alexander J C. Chylothorax review. Crit Care Med . 1985; 113 49-52
- 11 Bessone L, Ferguson T, Burford T. Chylothorax. Ann Thorac Surg . 1971; 12 527-550
- 12 Simmonds W. The effect of fluid, electrolytes and food intake on thoracic duct lymph flow in unanaesthetized rats. Aust J Exp Biol Med Sci . 1954; 32 285-291
- 13 Doolittle W, Ohmart M, Egan E. Congenital bilateral pleural effusion. AJDC . 1973; 125 435-437
- 14 Al-Arfaj A, Upadhyaya P, Al-Umran K. Current status of management of neonatal chylothorax. Indian J Pediatr . 1992; 59 133-136
- 15 Longaker T M, Laberge J M, Dansereau J. Primary fetal chylothorax: natural history and management. J Pediatr Surg . 1989; 24 573-576
- 16 Takeuchi K, Moriyama T, Oomori S, Masuko K, Maruo T. Management of acute chylothorax with hydrops fetalis diagnosed in the third trimester of pregnancy. Fetal Diagn Ther . 1999; 14 264-265
- 17 Brodman R, Zavelson T, Schiebler G. Treatment of congenital chylothorax. J Pediatr . 1974; 85 516-517
- 18 Randolph J, Gross R. Congenital chylothorax. Arch Surg . 1957; 74 405-409
- 19 Allen M E, Van Heekeren D W, Spector M L, Blumer J L. Management of nutritional and infectious complications of post-operative chylothorax in children. J Pediatr Surg . 1991; 26 1169-1174
- 20 Jensen G L, Mascioli E A, Meyer L P. Dietary modification of chyle composition in chylothorax. Gastroenterology . 1989; 97 761-765
- 21 Vain N, Swarnel O, Cha C. Neonatal chylothorax: a report and discussion of nine consecutive cases. J Pediatr Surg . 1980; 15 261-265
- 22 Gershanik J J, Jonsson H T, Riepel D A, Parker R M. Dietary management of neonatal chylothorax. Pediatrics . 1974; 53 400-405
- 23 Peitersen B, Jacbsen B B. Medium chain triglycerides for treatment of spontaneous neonatal chylothorax. Acta Pediatr Scand . 1977; 66 121-125
- 24 Puntis W LJ, Roberts D K, Handy D. How should chylothorax be managed?. Arch Dis Child . 1987; 62 593-596
- 25 Postima N G, Keyser S J. Management of persistent chylothorax. Otolaryngol-Head Neck Surg . 1997; 116 268-270
- 26 Perry R, Hodgman J, Cass A. Pleural effusion in the neonatal period. J Pediatr . 1963; 62 838-843
- 27 Engum S A, Rescorla F J, West K W, Scherer III T, Grosfeld J A. The use of pleuroperitoneal shunt in the management of persistent chylothorax in infants. J Pediatr Surg . 1999; 34 286-290
- 28 Merigan A B, Winter C D, O'Sullivan C G. Chylothorax. Br J Surg . 1997; 84 15-20
- 29 Milson W J, Kron L I, Rheuban S K, Rodgers M B. Chylothorax: an assessment of current surgical management. J Thorac Cardiovasc Surg . 1985; 89 221-227
- 30 Mart C B, Naunheim S K, Fiore C A, Pennington G. Conservative versus surgical management of chylothorax. Am J Surg . 1992; 164 532-535
- 31 Azizkhan R G, Canfield J, Alfoord B A, Rodgers B M. Pleuroperitoneal shunt in the management of neonatal chylothorax. J Pediatr Surg . 1983; 18 842-850
- 32 Ulibari J I, Sanz Y, Fuentes C, Mancha A, Armendia M, Sanchez S. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin [Letter]. Lancet . 1990; 336 258
- 33 Geons M B, Campbell D, Wiggins J W. Spontaneous chylothorax in Noonan syndrome treated with prednisone. AJDC . 1992; 146 1453-1456
- 34 Hagay Z, Reece A, Robert A, Hobbins J C. Isolated fetal pleural effusion: a prenatal management dilema. Obstet Gynecol . 1993; 81 147-152
- 35 McGillivary B C, Hall J G. Nonimmune hydrops fetalis. Pediatr Rev . 1987; 9 197-202