Treatment of fetal congenital chylothorax: Report of eight cases at a mainland Chinese medical center

Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018

BACKGROUND

Congenital chylothorax (CCT) of the newborn is a rare entity but the most common cause of pleural effusion in this age-group. We aimed to find the optimal treatment strategy.

MATERIAL AND METHODS

A PubMed search was performed according to the PRISMA criteria. All cases were analyzed according to prenatal, perinatal, and postnatal treatment modalities and follow-ups.

RESULTS

We identified 753 cases from 157 studies published between 1990 and 2018. The all-cause mortality rate was 28%. Prematurity was present in 71%, male gender dominated 57%, mean gestational age was 34 weeks, and birth weight was 2,654 g. Seventy-nine percent of newborns had bilateral CCT, the most common associated congenital anomalies with CCT were pulmonary lymphangiectasia and pulmonary hypoplasia, and the most common chromosomal aberrations were Down, Noonan, and Turner syndromes, respectively. Mechanical ventilation was reported in 381 cases for mean 17 (range 1-120) days; pleural punctuations and drainages were performed in 32% and 64%, respectively. Forty-four percent received total parenteral nutrition (TPN) for mean 21 days, 46% medium-chain triglyceride (MCT) diet for mean 37 days, 20% octreotide, and 3% somatostatin; chemical pleurodesis was performed in 116 cases, and surgery was reported in 48 cases with a success rate of 69%. In 462 cases (68%), complete restitution was reported; in 34 of 44 cases (77%), intrauterine intervention was carried out.

CONCLUSION

Respiratory support, pleural drainages, TPN, and MCT diet as octreotide remain to be the cornerstones of CCT management. Pleurodesis with OK-432 done prenatally and povidone-iodine postnatally might be discussed for use in life-threatening CCT.

[A clinical analysis of neonatal chylous effusions]

OBJECTIVE

To study the clinical features, etiology, treatment, and prognosis of neonatal chylous effusions.

METHODS

A retrospective analysis was performed for the clinical data of 21 neonates with chylous effusions.

RESULTS

Among these 21 neonates, 13 had chylothorax, 2 had chyloperitoneum, 2 had chylopericardium, and 4 had chylous polyserositis. Five neonates with congenital chylous effusions were enrolled as the congenital group, which mostly occurred in the fetal period, and symptoms were observed shortly after birth. Sixteen neonates with acquired chylous effusions were enrolled as the acquired group, and the symptoms mainly appeared within 1 week after central venous catheterization (in 14 neonates) or appeared together with sepsis (in 2 neonates). Compared with the acquired group, the congenital group had significantly higher specific gravity, white blood cell count, monocyte percentage, and albumin level in effusions (P<0.05) and significantly lower levels of glucose and triglyceride (P<0.05). Central venous catheterization-induced chylous effusions were mainly associated with inappropriate position, displacement damage, and hypertonicity. Conservative treatment was the main treatment method for the neonates with chylous effusions (in 20 children), with a response rate of 85%. Compared with the acquired group, the congenital group had a significant higher proportion of neonates receiving special formula feeding, a significantly lower proportion of neonates with extubation, and a significantly longer time to the absorption of effusions (P<0.05).

CONCLUSIONS

The time to the occurrence of symptoms and clinical manifestations vary with disease etiology and location in neonates with chylous effusions. Neonates with acquired chylous effusions may experience hypertonic solution effusion due to vascular injury. Conservative treatment has a marked clinical effect on neonatal chylous effusions. It appears to be more difficult to treat neonates with congenital chylous effusions than those with acquired chylous effusion.