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Nukaga S, Numano F, Saitoh A. Successful oral midodrine therapy for treatment of refractory postoperative chylothorax in an infant. Cardiol Young 2024:1-2. [PMID: 38660770 DOI: 10.1017/s1047951124025046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Refractory chylothorax, a postoperative complication of CHD, is difficult to manage and sometimes fatal. Herein, we report the case of a 10-month-old infant with 22-mosaic trisomy and a coarctation complex, who developed refractory chylothorax after cardiac repairs and was successfully treated with midodrine, an oral alpha-1-adrenoreceptor agonist. Midodrine may be used as adjunctive therapy for postoperative refractory chylothorax.
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Affiliation(s)
- Shunsuke Nukaga
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fujito Numano
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Wang B, Feng Y, Guo Y, Kan Q, Zou Y, Wu Y, Zheng M, Cheng R. Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China. J Cardiothorac Surg 2022; 17:276. [PMID: 36303149 PMCID: PMC9615329 DOI: 10.1186/s13019-022-02009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/24/2022] [Indexed: 11/14/2022] Open
Abstract
Objective Congenital chylothorax (CC) is an uncommon congenital disease. The objective of this study was to analyze the clinical features, treatment, and outcome of infants with CC in a Chinese tertiary medical center. Methods CC was defined as a non-traumatic pleural effusion with ≥ 80% lymphocytes detected before birth or within 28 days after birth. Clinical data were collected in CC infants discharged from June 2017 to March 2021. Results A total of 24 CC infants were discharged during the study period, accounting for 67% of congenital pleural effusions. The median gestational age at birth was 36+4 weeks (range 29+5–41 weeks) and the birth weight was 3025 g (range 1850–4250 g). Twenty-one infants were diagnosed antenatally. The median gestational age at the time of diagnosis was 30+3 weeks (range 24–36+6 weeks). Nine infants presented with hydrops fetalis; 18 were bilateral. Prenatal interventions were performed in 13 fetuses. Nine infants (38%) had birth asphyxia. Compared with the infants without hydrops fetalis, the infants with CC and hydrops fetalis had lower Apgar scores at 1 and 5 min (P < 0.05) and a lower gestational age at birth (P < 0.05). Postnatally, 17 infants required continuous pleural drainage for 10 days (range 2–30 days). Analysis of the pleural effusion showed a higher cell count, lymphocyte fraction, and protein content after enteral feeding (P < 0.05). Fifteen infants required mechanical ventilation; 9 did not require any respiratory support. Ten infants received a delayed feeding strategy and 17 received a medium-chain triglyceride (MCT) formula. Only 1 infant received octreotide therapy. Twenty-one infants survived and 3 died. The main cause of death was pulmonary dysplasia. The duration of hospital stay in survivors was 21.5 days (range 10–43) days. For infants with CC and hydrops fetalis, prenatal therapy shortened the duration of pleural drainage and the length of hospital stay (P < 0.05). Conclusion CC is the most common cause of congenital pleural effusions. The poor prognosis is mainly associated with prematurity, hydrops fetalis, and pulmonary dysplasia. Prenatal intervention may improve the outcome of infants with hydrops fetalis.
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Affiliation(s)
- Beibei Wang
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yun Feng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yan Guo
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Qing Kan
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yunsu Zou
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yue Wu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China.
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Rocha G, Arnet V, Soares P, Gomes AC, Costa S, Guerra P, Casanova J, Azevedo I. Chylothorax in the neonate-A stepwise approach algorithm. Pediatr Pulmonol 2021; 56:3093-3105. [PMID: 34324269 DOI: 10.1002/ppul.25601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. METHODS An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. DISCUSSION AND CONCLUSION The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vanessa Arnet
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Gomes
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Paula Guerra
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Casanova
- Department of Cardiothoracic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit, Public Health Institution, University of Porto, Porto, Portugal
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