Conservative management of chylothorax in infants using octreotide
DOI:
https://doi.org/10.18203/2349-2902.isj20205358Keywords:
Congenital chylothorax, Octreotide, SomatostatinAbstract
Background: Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates and infants. Chylothorax causes respiratory and nutritional problems and has a significant mortality rate. Octreotide is a long-acting somatostatin analogue that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.
Methods: Infants with spontaneous chylothorax over a period of 3 years were included in this study. A prospective, observational study was done. All patients were nil per oral initially. Oral feeds were resumed once the ICD output declined. Octreotide was given subcutaneously for all patients at a dose of 40 microgram/kg/day in 3 divided doses. Octreotide was stopped once the ICD output was less than 70-80 ml/day. ICD was inserted in all patients and removed once drainage was below 50 ml/day.
Results: Five patients were diagnosed with chylothorax over a period of 3 years out of which 3 were male and 2 were females. 1 patient had right sided and 4 patients had left sided chylothorax. The average age of presentation was 5.6 months. Octreotide was administered for an average of 14.4 days (8-22 days). The average duration of ICD was 18.2 days. All patients recovered well and were discharged.
Conclusions: Spontaneous chylothorax is rare in infants. Conservative management is usually successful. Early institution of oral feeds with octreotide preserves the child’s nutrition and avoids invasive procedures, such as reinsertion of chest tubes or surgery.
References
Martinez SM, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009;10(4):199-207.
Roehr CC, Jung A, Proquitte H. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32:650e7.
Kurtz TW, Hsu CH. Resolution of chylothorax after positive end-expiratory pressure ventilation. Arch Surg. 1980;115(1):73-4.
McCray S, Parrish CR. Nutritional management of chyle leaks: an update. Practical Gastroenterol Series. 2011;94:12-32.
Panthongviriyakul C, Bines JE. Post-operative chylothorax in children: an evidence-based management algorithm. J Paediatr Child Health. 2008;44(12):716-21.
Kalomenidis I. Octreotide and chylothorax. Curr Opin Pulm Med. 2006;12(4):264-7.
Shah D, Sinn JK. Octreotide as therapeutic option for congenital idiopathic chylothorax: a case series. Acta Paediatr. 2012;101(4):e151-5.
Roehr CC, Jung A, Proquitté H. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32(5):650-7.
Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev. 2010;(9):CD006388.
Horvers M, Mooij CF, Antonius TA. Is octreotide treatment useful in patients with congenital chylothorax? Neonatology. 2012;101(3):225-31.
Berkenbosch JW, Withington DE. Management of postoperative chylothorax with nitric oxide: a case report. Crit Care Med. 1999;27(5):1022-24.
Stringel G, Mercer S, Bass J. Surgical management of persistent postoperative chylothorax in children. Can J Surg. 1984;27(6):543-6.
Fernandes PM, Nascimbem MB, Ranzani OT, Shimoda MS, Monteiro R, Jatene FB. Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children. J Bras Pneumol. 2011;37(1):28-35.
Nath DS, Savla J, Khemani RG. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg. 2009;88(1):246-51.
Achildi O, Smith BP, Grewal H. Thoracoscopic ligation of the thoracic duct in a child with spontaneous chylothorax. J Laparoendosc Adv Surg Tech A. 2006;16(5):546-9.
Aoki M, Kato F, Saito H, Mimatsu K, Iwata H. Successful treatment of chylothorax by bleomycin for Gorham’s disease. Clin Orthop Relat Res. 1996;(330):193-7.
Ono S, Iwai N, Chiba F, Furukawa T, Fumino S. OK-432 therapy for chylous pleural effusion or ascites associated with lymphatic malformations. J Pediatr Surg. 2010;45(9):e7-e10.
Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, Deschamps C. Treatment of symptomatic primary chylous disorders. J Vasc Surg. 2001;34(5):785-91.
Engum SA, Rescorla FJ, West KW, Scherer LR III, Grosfeld JL. The use of pleuroperitoneal shunts in the management of persistent chylothorax in infants. J Pediatr Surg. 1999;34(2):286-90.
