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Surgical chylothorax in neonates: management and outcomes

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Abstract

Background

Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic procedure. This study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in neonates.

Methods

PubMed database was searched for articles in English, Portuguese and Spanish from 2000 to 2016. Data were collected for surgery, chylothorax management, complications, mortality and length of hospital stay (LOS).

Results

Twenty studies offered 107 neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH + extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT) was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three patients (2.8%) did not require any treatment. Octreotide and somatostatin were used as second or third line treatment in 25 neonates (23.4%), and 15 neonates (14%) underwent 17 surgeries, including thoracic duct ligation (TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL + pleurodesis (n = 2), and TDL + placement of hemostat (n = 1). Complications due to the chylothorax were reported in 27 neonates (25.2%): hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4), hypoalbuminemia with cutaneous flushing as colateral effect of somatostatin (n = 1), loose stool after somatostatin use (n = 1), pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4 days (30–93.1 days).

Conclusions

Conservative management is appropriate as initial treatment for neonatal postsurgical chylothorax. Octreotide and somatostatin are safe in neonates and surgical approach should be considered in prolonged leaks.

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Funding

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK

    Karina Miura Costa & Amulya Kumar Saxena

  2. Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

    Karina Miura Costa & Amulya Kumar Saxena

Authors
  1. Karina Miura Costa
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Contributions

CKM contributed to concept and design, acquisition, analysis and interpretation of data; drafting of the article. SAK contributed to concept and design, acquisition, analysis and interpretation of data; revising the article critically for important intellectual content. Both authors approved the final version to be published.

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Correspondence to Amulya Kumar Saxena.

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Costa, K.M., Saxena, A.K. Surgical chylothorax in neonates: management and outcomes. World J Pediatr 14, 110–115 (2018). https://doi.org/10.1007/s12519-018-0134-x

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  • DOI: https://doi.org/10.1007/s12519-018-0134-x

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