Skip to main content
SpringerLink
Log in

Congenital chylothorax treated with octreotide

  • Clinical Brief
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the pediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. A 33 week gestation female infant, born with the presence of large bilateral pleural effusion, was unresponsive to conservative management. Octreotide was commenced on day 15, with 10 days of an octreotide infusion, initially 0.5 μg/kg per hour and increased daily by 1 ug/kg per hour to 10 μg/kg per hour. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage over the 10 day. She remains well at 6 months of age. Further studies are required to ascertain its true value in congenital chylothorax.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smeltzer DM, Stickler GB, Fleming RE. Primary lymphatic dysplasia in children: Chylothorax, chylous ascites, and generalised lymphatic dysplasia.Eur J Pediatr 1986; 45:286–292.

    Article  Google Scholar 

  2. Levine C. Primary disorders of the lymphatic vessels-a unified concept.J Pediatr Surg 1989; 24: 233–240.

    Article  PubMed  CAS  Google Scholar 

  3. Hilliard RI, McKendry JB, Phillips MJ. Congenital abnormalities of the lymphatic system: a new clinical classification.Pediatr 1990; 86:988–994.

    CAS  Google Scholar 

  4. Adiotomre PN, Burns JE, Mclntosh N. Hydrops foetalis and chylothorax associated with superior caval vein obstruction and resolution following balloon dilatation.Acta Pediatr 1994; 83:983–985.

    CAS  Google Scholar 

  5. Easa D, Balaraman V, Ash K, Thompson B, Boychuk R. Congenital Chylothorax and mediastinal neuroblastoma.Pediatric Surg 1991; 26:96–98.

    Article  CAS  Google Scholar 

  6. Hesseling PB, Hoffman H. Chylothorax: a review of the literature and report of 3 cases.S Afr Med 1981; 60:675–678.

    CAS  Google Scholar 

  7. Ho NK, Leong NK, Lim SB. Chylothorax in Down’s syndrome associated with hydrops fetalis.J Singapore Pediatr Soc 1989; 31: 90–92.

    CAS  Google Scholar 

  8. Harvey JG, Houlsby W, Sherman K, Gough MH. Congenital Chylothorax: report of unique case associated with H-type tracheooesophageal fistula.Br J Surg 1979; 66:485–487.

    Article  PubMed  CAS  Google Scholar 

  9. Azizkhan RG, Canfield J, Alford BA, Rodgers BM. Pleuroperitoneal shunts in the management of neonatal chylothorax.J Pediatric Surg 1983; 18:842–850.

    Article  CAS  Google Scholar 

  10. Anderson EA, Hertel J, Pedersen SAet al. Congenital chylothorax: Management by ligature of the thoracic duct.Scand J Thorac Cardiovasc Surg 1984; 18:193–194.

    Google Scholar 

  11. Al-Tawil K, Ahmed G, Al-Hathal M, Al-Jarallah Y, Campbell N. Congenital chylothorax.Am J Perinatol 2000; 17:121–126.

    Article  PubMed  CAS  Google Scholar 

  12. Wolff AB, Silen ML, Kokoska ER, Rodgers BM. Treatment of refractory chylothorax with externalised pleuroperitoneal shunts in children.Ann Thorac Surg 1999; 68:1053–1057.

    Article  PubMed  CAS  Google Scholar 

  13. Buettiker V, Hug ML Burger R, Baenziger O. Somatostatin: A new therapeutic option for the treatment of chylothorax.Intens Care Med 2001; 27: 1083–1086.

    Article  CAS  Google Scholar 

  14. Rosti L, Bird RM, Chessa M, Butera G, Drago M, Carminati M. The effectiveness of octreotide in the treatment of postoperative chylothorax.Eur J Pediatr 2002; 161:149–150.

    Article  PubMed  CAS  Google Scholar 

  15. Cheung Y, Leung MP, Yip M. Octreotide for treatment of postoperative chylothorax.J Pediatr 2001; 139:157–159.

    Article  PubMed  CAS  Google Scholar 

  16. Pratap U, Slavik Z, Ofoe VD, Franklin R. Octreotide to treat postoperative chylothorax after cardiac operations in children.Ann Thorac Surg 2001; 72:1740–1742.

    Article  PubMed  CAS  Google Scholar 

  17. Lam JC, Aters S, Tobias JD. Initial experience with Octreotide in the pediatrie population.Am J Ther 2001; 8:409–415.

    Article  PubMed  CAS  Google Scholar 

  18. Rasiah SV, Oei J, Lui K. Octreotide in the treatment of congenital chylothorax.J Pediatr Child Health 2004; 40:585–588.

    Article  CAS  Google Scholar 

  19. Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C. Etiology and management of pediatrie chylothorax.J Pediatrics 2000; 136:653–658.

    Article  CAS  Google Scholar 

  20. Chernick V, Reed MH. Pneumothorax and chylothorax in the neonatal period.J Pediatrics 1970; 76:624–632.

    Article  CAS  Google Scholar 

  21. Dubin PJ, King IN, Gallagher PG. Congenital Chylothorax.Curr Opin Pediatr 2000; 12:505–509.

    Article  PubMed  CAS  Google Scholar 

  22. Mulvihill S, Pappas TN, Passaro E Jr, Debas HT. The use of somatostatin and its analogs in the treatment of surgical disorders.Surgery 1986; 100:467–475.

    PubMed  CAS  Google Scholar 

  23. Siafakas C, Fox VL, Nurko S. Use of octreotide for the treatment of severe gastrointestinal bleeding in children.J Pediatr Gastrxnterol Nutr 1998; 26:356–359.

    Article  CAS  Google Scholar 

  24. Tauber MT, Harris AG, Rochiccioli P. Clinical use of the long acting somatostatin analogue octreotide in pediatrics.Eur J Pediatr 1994; 153:304–310.

    Article  PubMed  CAS  Google Scholar 

  25. Lamberts SWJ, van der Lely AJ, de Herder WW, Hofland LJ. Drug therapy: Octreotide.N Engl J Med 1996; 334: 246–254.

    Article  PubMed  CAS  Google Scholar 

  26. Glaser B, Hirsch HJ, Landau H. Persistent hyperinsulinemic hypoglycaemia of infancy: long-term octreotide treatment without pancreatectomy.J Pediatr 1993; 123: 644–650.

    Article  PubMed  CAS  Google Scholar 

  27. Davis SN, Granner DK. Insulin, oral hypoglycaemic agents and the pharmacology of the endocrine pancreas. In AG Gilmand, JG Hardman, LE Limbird, PB Molionaff, RW Ruddon, eds.Goodman and Gilman’s the Pharmacological Basis of Therapeutics, 9th (ed). New York; Pergamon Press, 1996; 1512–1513.

    Google Scholar 

  28. Nakabayashi H, Sagara H, Usukura N, Yoshimitsu K, Imamura T, Seta T, Yanase E, Kawato M, Hiraiwa Y, Sakato S, Takeda R. Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomised dogs.Diabetes 1981; 30:440–445.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, SSK Region Hospital and Medical Faculty of Gaziantep University, Turkey

    Yasin Sahin MD & Derya Aydin

Authors
  1. Yasin Sahin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Derya Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasin Sahin MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sahin, Y., Aydin, D. Congenital chylothorax treated with octreotide. Indian J Pediatr 72, 885–888 (2005). https://doi.org/10.1007/BF02731124

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02731124

Key words

Search

Navigation