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Chylothorax in newborns after cardiac surgery: a rare complication?

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Abstract

The aim of this study was to analyze patients diagnosed with chylothorax after congenital heart disease surgery among a cohort of neonatal patients, comparing the evolution, complications, and prognosis after surgery of patients who were and were not diagnosed with chylothorax, and to analyze possible risk factors that may predict the appearance of chylothorax in this population. Retrospective and observational study included all neonates (less than 30 days since birth) who underwent congenital heart disease surgery in a level III neonatal intensive care department. We included infants born between January 2014 and December 2019. We excluded those infants who were born before 34 weeks of gestational age or whose birth weight was less than 1800 g. We also excluded catheter lab procedures and patent ductus arteriosus closure surgeries. Included patients were divided into two groups depending on whether they were diagnosed with chylothorax or not after surgery, and both groups were compared in terms of perinatal-obstetrical information, surgical data, and NICU course after surgery. We included 149 neonates with congenital heart disease surgery. Thirty-one patients (20.8%) developed chylothorax, and in ten patients (32.3%), it was considered large volume chylothorax. Regarding the evolution of these patients, 22 infants responded to general dietetic measures, a catheter procedure was performed in 9, and 5 of them finally required pleurodesis. Cardiopulmonary bypass, median sternotomy, and delayed sternal closure were the surgical variables associated with higher risks of chylothorax. Patients with chylothorax had a longer duration of inotropic support and mechanical ventilation and took longer to reach full enteral feeds. As complications, they had higher rates of cholestasis, catheter-related sepsis, and venous thrombosis. Although there were no differences in neonatal mortality, patients with chylothorax had a higher rate of mortality after the neonatal period. In a multiple linear regression model, thrombosis and cardiopulmonary bypass multiplied by 10.0 and 5.1, respectively, the risk of chylothorax and have an umbilical vein catheter decreases risk.

Conclusion: We have found a high incidence of chylothorax after neonatal cardiac surgery, which prolongs the average stay and causes significant morbidity and mortality. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during the neonatal period.

What is Known:

• Acquired chylothorax in the neonatal period usually appears as a complication of congenital heart disease surgery, being the incidence quite variable among the different patient series (2.5–16.8%). The appearance of chylothorax as a complication of a cardiac surgery increases both mortality and morbidity in these patients, which makes it a quality improvement target in the postsurgical management of this population.

What is New:

•Most of the published studies include pediatric patients of all ages, from newborns to teenagers, and there is a lack of studies focusing on neonatal populations. The main strength of our study is that it reports, to the best of our knowledge, one of the largest series of neonatal patients receiving surgery for congenital heart disease in the first 30 days after birth. We have found a high incidence of chylothorax after cardiac surgery during the neonatal period compared to other studies. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during this period of life.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicity available, but are available from the corresponding author on a reasonable request.

Abbreviations

CLFD:

Central lymphatic flow disorder

CoA:

Coarctation of the aorta

CP:

Chyloperitoneum

CT:

Chylothorax

CRBSI:

Catheter-related bloodstream infection

ECC:

Extra corporeal circulation

ECMO:

Extracorporeal membrane oxygenation

HLHS:

Hypoplastic left heart syndrome

IQR:

Median and interquartile ranges

LVC:

Large volume chylothorax

MCT:

Medium chain triglyceride formula

PICC:

Peripherally inserted central catheter

PLPS:

Pulmonary lymphatic perfusion syndrome

RACHS:

Risk Adjusted Congenital Heart Surgery Score

TAPVR:

Total anomalous pulmonary venous return

TGA:

Transposition of the great arteries

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Authors and Affiliations

  1. Neonatology Department, Hospital General Universitario Gregorio Marañón, O’Donnell 48, Madrid, 28009, Spain

    Alba Pérez-Pérez, Sara Vigil-Vázquez, Ana Gutiérrez-Vélez & Manuel Sánchez-Luna

  2. Neonatology Deparment, The Hospital for Sick Children, Toronto, Canada

    Gonzalo Solís-García

  3. Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    María López-Blázquez, Jose Luis Zunzunegui Martínez & Constancio Medrano López

  4. Pediatric Cardiac Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Juan Miguel Gil-Jaurena

  5. Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Juan Carlos de Agustín-Asensio

Authors
  1. Alba Pérez-Pérez
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Contributions

Alba Pérez-Pérez and Sara Vigil-Vázquez designed the study, performed the acquisition and analysis of the data, and draft the text. Gonzalo Solís-García and Ana Gutiérrez-Vélez collected data. The rest of the authors made contributions to the conception of the work and revised the work critically. All the authors revised and approved the final version of the text.

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Correspondence to Alba Pérez-Pérez.

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The study was approved by the Hospital Research Ethics Committee.

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Communicated by Daniele De Luca.

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Pérez-Pérez, A., Vigil-Vázquez, S., Gutiérrez-Vélez, A. et al. Chylothorax in newborns after cardiac surgery: a rare complication?. Eur J Pediatr 182, 1569–1578 (2023). https://doi.org/10.1007/s00431-023-04808-5

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