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Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review

  • Systematic Review
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Abstract

Objective

Chylothorax is a rare but life-threatening condition in children. To date, there is no commonly accepted treatment protocol. Somatostatin and octreotide have recently been used for treating chylothorax in children. We set out to summarise the evidence on the efficacy and safety of somatostatin and octreotide in treating young children with chylothorax.

Design

Systematic review: literature search (Cochrane Library, EMBASE and PubMed databases) and literature hand search of peer reviewed articles on the use of somatostatin and octreotide in childhood chylothorax.

Patients

Thirty-five children treated for primary or secondary chylothorax (10/somatostatin, 25/octreotide) were found.

Results

Ten of the 35 children had been given somatostatin, as i.v. infusion at a median dose of 204 μg/kg/day, for a median duration of 9.5 days. The remaining 25 children had received octreotide, either as an i.v. infusion at a median dose of 68 μg/kg/day over a median 7 days, or s.c. at a median dose of 40 μg/kg/day and a median duration of 17 days. Side effects such as cutaneous flush, nausea, loose stools, transient hypothyroidism, elevated liver function tests and strangulation-ileus (in a child with asplenia syndrome) were reported for somatostatin; transient abdominal distension, temporary hyperglycaemia and necrotising enterocolitis (in a child with aortic coarctation) for octreotide.

Conclusions

A positive treatment effect was evident for both somatostatin and octreotide in the majority of reports. Minor side effects have been reported, however caution should be exercised in patients with an increased risk of vascular compromise as to avoid serious side effects. Systematic clinical research is needed to establish treatment efficacy and to develop a safe treatment protocol.

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Abbreviations

AVC:

atrio-ventricular canal

CHD:

congenital heart disease

GA:

gestational age

i.v.:

intravenous

NEC:

necrotising enterocolitis

OCT:

octreotide

POD:

postoperative day

s.c.:

subcutaneous

SST:

somatostatin

TAPVC:

total anomalous pulmonary venous connection

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Acknowledgements

We would like to thank Dr. Julia Kresing for translating the Spanish article into German and Ms Jessica Blank for helping with the extensive literature search.

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Authors and Affiliations

  1. Department of Neonatology, Charité Campus Mitte, Universitätsmedizin Berlin, Schumannstraße 20–21, 10098, Berlin, Germany

    Charles C. Roehr, Andreas Jung, Hans Proquitté, Hannes Hammer & Roland R. Wauer

  2. Department of Paediatric Endocrinology, Charité Campus Virchow, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Oliver Blankenstein

  3. Department of Paediatric Surgery, University of Oxford and John Radcliffe Hospital, OX3 9DU, Oxford, UK

    Kokila Lakhoo

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  1. Charles C. Roehr
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  2. Andreas Jung
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  5. Hannes Hammer
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  7. Roland R. Wauer
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Correspondence to Charles C. Roehr.

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No funding was provided for the review, there were no conflicting interests.

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Roehr, C.C., Jung, A., Proquitté, H. et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med 32, 650–657 (2006). https://doi.org/10.1007/s00134-006-0114-9

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  • DOI: https://doi.org/10.1007/s00134-006-0114-9

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