Pediatric Surgery International

, Volume 22, Issue 7, pp 585–588 | Cite as

Pleural effusion requiring drainage in congenital diaphragmatic hernia: incidence, aetiology and treatment

  • G. Casaccia
  • F. Crescenzi
  • S. Palamides
  • O. A. Catalano
  • P. Bagolan
Original Article


In congenital diaphragmatic hernia (CDH), chest tube insertion at repair could determine rapid overexpansion of hypoplastic lungs, increasing the risk of pneumothorax. Therefore, in our institution no drainage tube at CDH repair was inserted after 1997. Afterwards several patients needed chest drainage for cardiopulmonary distress due to pleural effusion (PE) during the postoperative course. The aims of this study are to establish the incidence of PE requiring drainage for cardiopulmonary distress during postoperative course in CDH and to assess its eventual increase in patients with patch repair. Furthermore, the aetiology and treatment of PE are highlighted. Records of high-risk CDH operated on from 1998 to 2004 were reviewed. No chest tube was inserted at repair. Drainage was accomplished postoperatively if a cardiopulmonary distress due to PE occurred. Groups with and without patch were compared on gender, gestational age, birth weight, side of hernia, PE, hernial sac, central venous line and venous thrombosis, using the χ2 and Student’s t tests. Overall mortality rate was recorded. Out of 76 patients, 23 (30%) required patch repair. The PE occurred in 22 out of 76 patients, and in 68% of cases a chylothorax resulted. Birth weight was significantly lower, and the PE rate was significantly higher in patients with patch. Pleural drainage yielded improvement of ventilatory and respiratory parameters in all cases. Overall mortality rate was 16 and 23% in patients that required chest drain. The incidence of PE was 30% in CDH and significantly higher in patients with patch. The increased mortality rate in patients with PE causing cardiopulmonary distress warrants chest tube drainage before instability occurs.


Pleural Effusion Total Parenteral Nutrition Chest Tube Congenital Diaphragmatic Hernia Superior Vena Cava 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wung JT, Sahni R, Moffitt ST et al (1995) Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 30:406–409PubMedCrossRefGoogle Scholar
  2. 2.
    Cloutier R, Allard V, Fournier L et al (1993) Estimation of lungs’ hypoplasia on postoperative chest x-rays in congenital diaphragmatic hernia. J Pediatr Surg 28:1086–1089PubMedCrossRefGoogle Scholar
  3. 3.
    Bagolan P, Casaccia G, Crescenzi F et al (2003) Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia. J Pediatr Surg 39:313–318CrossRefGoogle Scholar
  4. 4.
    Hanekamp MN, Tjin A, Djie GCM et al (2003) Does V-A ECMO increase the likelihood of chylothorax after congenital diaphragmatic hernia repair? J Pediatr Surg 38:971–974PubMedCrossRefGoogle Scholar
  5. 5.
    Kavvadia V, Greenough A, Davenport M et al (2003) Chylothorax after repair of congenital diaphragmatic hernia—risk factor and morbidity. J Pediatr Surg 38:500–502Google Scholar
  6. 6.
    Naik S, Greenough A, Zhang Y-X et al (1996) Prediction of morbidity during infancy following congenital diaphragmatic hernia repair. J Pediatr Surg 31:1651–1654PubMedCrossRefGoogle Scholar
  7. 7.
    Beghetti M, La Scala G, Belli D et al (1999) Etiology and management of pediatric chylothorax. J Pediatr 136:653–658Google Scholar
  8. 8.
    Blalock A, Cunningham RS, Robinson CS (1986) Experimental production of chylothorax by occlusion of the superior vena cava. Ann Surg 104:359–364CrossRefGoogle Scholar
  9. 9.
    Dhande V, Kattwinkel J, Alford B (1983) Recurrent bilateral pleural effusion secondary to superior vena cava obstruction as a complication of central venous catheterization. Pediatrics 72:109–113PubMedGoogle Scholar
  10. 10.
    Khalil BA, Jesudason EC, Featherstone NC, Sarginson R, Kerr S, Ashworth M, Losty PD (2005) Hidden pathologies associated with (and concealed by) early gestational isolated fetal hydrothorax. J Pediatr Surg 40(7):e1–e3PubMedCrossRefGoogle Scholar
  11. 11.
    Goyal A, Smith NP, Jesudason EC, Kerr S, Losty PD (2003) Octreotide for treatment of chylothorax after repair of congenital diaphragmatic hernia. J Pediatr Surg 38(8):e19–e20PubMedCrossRefGoogle Scholar
  12. 12.
    The Congental Diaphragmatic Hernia Study Group (2001) Estimating disease severity of congenital diaphragmatic hernia in the first five minutes of life. J Pediatr Surg 36:41–45Google Scholar
  13. 13.
    Clark RH, Hardin WH Jr, Hirschl RB et al (1998) For the Congenital Diaphragmatic Hernia Study Group. Current surgical management of Congenital Diaphragmatic Hernia: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 33:1004–1009PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • G. Casaccia
    • 1
  • F. Crescenzi
    • 2
  • S. Palamides
    • 2
  • O. A. Catalano
    • 3
  • P. Bagolan
    • 1
  1. 1.Neonatal Surgery Unit, Department of Medical and Surgical NeonatologyBambino Gesù Pediatric HospitalRomeItaly
  2. 2.Neonatal Intensive Care Unit, Department of Medical and Surgical NeonatologyBambino Gesù Pediatric HospitalRomeItaly
  3. 3.U.O. RadiologyA.O. RummoBeneventoItaly

Personalised recommendations