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Evidence-based management of chylothorax in infants.

Abstract：

PURPOSE:Management guidelines for infants with chylothorax lack substantial evidence. We sought to identify variables that impact outcomes in these patients in order to develop an evidence-based management algorithm. METHODS:We retrospectively reviewed the medical records of all infants diagnosed with chylothorax from June 2005 to December 2014 at our institution. Data collected included demographics, chest tube output (CTO), medical and dietary interventions, surgical procedures, and absolute lymphocyte count (ALC). Outcomes analyzed included death, sepsis, necrotizing enterocolitis (NEC), requiring surgery, and success of therapy, defined as CTO decrease by >50% within 7days. RESULTS:Of 178 neonates with chylothorax, initial therapy was high medium chain triglyceride (MCT) feedings in 106 patients, nothing by mouth (NPO), total parenteral nutrition (TPN) in 21, and NPO/TPN plus octreotide in 45. Octreotide use in addition to NPO/TPN revealed no significant differences in any outcome including success (47% vs. 43%, p=0.77). Initial CTO and ALC correlated with needing surgery (p=0.002 and p=0.006, respectively), and with death (p=0.028 and p=0.043, respectively). ALC also correlated with sepsis (p<0.001). CONCLUSIONS:Octreotide has no advantage over NPO/TPN alone in infants with chylothorax. CTO and ALC predict requiring surgery. We propose a management guideline based on CTO and ALC without a role for octreotide. TYPE OF STUDY:Retrospective case-control study. LEVEL OF EVIDENCE:3.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Church JT,Antunez AG,Dean A,Matusko N,Deatrick KB,Attar MA,Gadepalli SK

doi

10.1016/j.jpedsurg.2017.03.010

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

907-912

issue

6

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(17)30159-8

journal_volume

52

pub_type

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