1
|
Toptan HH, Ozalkaya E, Karadag N, Topcuoglu S, Dincer E, Karatekin G. Neonatal Lymphatic Flow Disorder. Indian J Pediatr 2024; 91:248-253. [PMID: 37040015 DOI: 10.1007/s12098-023-04531-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To examine and discuss patients diagnosed with acquired and congenital chylothorax in the neonatal period in the light of the literature. METHODS The files of newborns followed-up in the neonatal intensive care unit (NICU) and diagnosed with congenital and acquired chylothorax were reviewed retrospectively. Patients with isolated chylothorax were classified as Group 1 and those with multiple lymphatic flow disorders were classified as Group 2. Antenatal and clinical features were recorded and compared between the groups. RESULTS Thirteen infants were diagnosed with chylothorax; 92.3% (n = 12) of the patients were congenital. The rate of antenatal diagnosis was 61.5% (n = 8). Eight patients (61.5%) were diagnosed with hydrops fetalis. Among the cases in Group 1 and Group 2, receiving ocreotide and the incidence of sepsis (p = 0.05) were partially significant. Seven of the patients (66.6%) responded to medium chain triglycerides (MCT), and complete resolution was seen in 6 (85.7%) of the responders. Complete resolution of chylothorax fluid was observed in 7 (77.7%) of nine patients who responded to ocreotide treatment. CONCLUSIONS In neonatal chylothorax, the postnatal period includes a multidisciplinary approach that requires drug therapy, dietary modifications, drainage of pleural fluid, and rarely, surgery.
Collapse
Affiliation(s)
- Handan Hakyemez Toptan
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey.
| | - Elif Ozalkaya
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Emre Dincer
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Guner Karatekin
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| |
Collapse
|
2
|
Handal-Orefice R, Midura D, Wu JK, Parravicini E, Miller RS, Shawber CJ. Propranolol Therapy for Congenital Chylothorax. Pediatrics 2023; 151:190476. [PMID: 36651059 DOI: 10.1542/peds.2022-058555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/19/2023] Open
Abstract
Congenital chylothorax is a rare and often severe anomaly without well-established medical therapies. Previously, propranolol use in patients with lymphatic malformations and secondary chylothorax was associated with improvement in clinical signs. We hypothesized that propranolol treatment would be beneficial for severe congenital chylothorax. We reviewed medical records of neonates born from 2015 to 2019 at our tertiary center with a prenatal diagnosis of congenital chylothorax for whom either prenatal or postnatal propranolol therapy was initiated. Inclusion was limited to fetuses diagnosed with severe congenital chylothorax without significant genetic, infectious, or cardiac anomalies, and who underwent prenatal interventions to mitigate consequences of the condition. Propranolol was administered orally to pregnant women at 20 mg 4 times daily and increased to a maximum dose of 40 mg 4 times daily, or to infants at 0.3 mg/kg/d and increased to 1 to 2 mg/kg/d. Primary outcomes were the time course of resolution of ultrasonographical, clinical, and/or radiologic signs of chylothorax after treatment with propranolol. Four neonates met the inclusion criteria. In 2 cases, prenatal initiation of propranolol led to resolution of the chylothoraxes before delivery (38 and 32 days after treatment) on a dose of 40 mg/day 4 times daily. Neonates had a normal postnatal course. Postnatal propranolol was initiated in 2 neonates with respiratory failure when chylothoraces were refractory to standard management. Stabilization and improvement of their pleural effusion was observed by imaging at 29 and 13 days after initiation of propranolol. There were no significant maternal or neonatal complications from prenatal or postnatal propranolol use. Propranolol may be efficacious in treating severe fetal congenital chylothorax.
Collapse
Affiliation(s)
| | - Devin Midura
- Surgery.,Contributed equally as co-first authors
| | | | - Elvira Parravicini
- Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | | | | | | |
Collapse
|
3
|
Nakano TA, Dori Y, Gumer L, Liptzin DR, Hill LRS, Kulungowski AM. How we approach pediatric congenital chylous effusions and ascites. Pediatr Blood Cancer 2022; 69 Suppl 3:e29246. [PMID: 36070215 DOI: 10.1002/pbc.29246] [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] [Received: 04/23/2021] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022]
Abstract
Congenital lymphatic leak may develop in patients with maldeveloped lymphatics and result in life-threatening fluid and electrolyte imbalance, protein deficiency, and immunodeficiency. Rapid diagnosis and therapy are necessary to prevent these complications; however, the field lacks clinical trials to support standardized diagnostic treatment guidelines. We present our current multidisciplinary approach to the diagnosis and management of congenital lymphatic leak including chylous pleural effusions and ascites. Depending on the rate of lymphatic leak, therapy can range from observation with nutritional modifications to surgical and interventional procedures aimed to reduce lymphatic drainage. Modalities to image central and peripheral lymphatics have advanced considerably. Genetic variants and subsequent targets that drive lymphatic maldevelopment have expanded the repertoire of possible pharmacotherapeutic options.
Collapse
Affiliation(s)
- Taizo A Nakano
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Yoav Dori
- Division of Cariology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lindsey Gumer
- Division of Pediatric Gastroenterology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lauren R S Hill
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ann M Kulungowski
- Vascular Anomalies Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| |
Collapse
|
4
|
Schneider S, Köllges R, Stegmann JD, Thieme F, Hilger AC, Waffenschmidt L, Fazaal J, Kalanithy JC, Geipel A, Strizek B, Ludwig KU, Reutter H, Müller A. Resequencing of VEGFR3 pathway genes implicate GJC2 and FLT4 in the formation of primary congenital chylothorax. Am J Med Genet A 2022; 188:1607-1611. [PMID: 34994518 DOI: 10.1002/ajmg.a.62643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Sophia Schneider
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Ricarda Köllges
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Jil D Stegmann
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Frederic Thieme
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Alina C Hilger
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Lea Waffenschmidt
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Julia Fazaal
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Jeshurun C Kalanithy
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Kerstin U Ludwig
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Heiko Reutter
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany.,Institute of Human Genetics, University Hospital Bonn, Bonn, Germany.,Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Nürnberg-Erlangen, Erlangen, Germany
| | - Andreas Müller
- Department of Neonatology and Paediatric Intensive Care, University Hospital Bonn Center of Paediatrics, Bonn, Germany
| |
Collapse
|
5
|
Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Chávez-González E, Villalobos-Gómez R, Cruz-Martínez R. Are pregnancies with severe fetal hydrothorax and very short cervix candidates for pleuroamniotic shunting? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:783-784. [PMID: 33998074 DOI: 10.1002/uog.23686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- A Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - H López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - E Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
| | - R Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal México, Hospital San José, Querétaro, Mexico
- Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| |
Collapse
|
6
|
Kambara M, Ibara S. Chylothorax as a complication of congenital myotonic dystrophy: A retrospective cohort study. Early Hum Dev 2021; 158:105396. [PMID: 34029782 DOI: 10.1016/j.earlhumdev.2021.105396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The association between congenital myotonic dystrophy (CMD) and chylothorax is poorly recognized. AIMS To evaluate the proportion of chylothorax in infants with CMD compared to its prevalence in infants without CMD. STUDY DESIGN Single-center, retrospective, cohort study. SUBJECTS Infants managed at a neonatal intensive care unit from 2003 to 2019. OUTCOME MEASURES CMD was diagnosed using Southern blot for the quantification of CTG repeats in the dystrophia myotonica protein kinase (DMPK) gene. Prenatal and postnatal data of eligible infants with CMD were collected from the patients' medical records. The primary outcome was the proportion of chylothorax. RESULTS While the proportion of chylothorax in eligible infants without CMD was 0.25% (27/10714), that in infants with CMD was 50% (5/10; odds ratio (OR), 386.3; 95% confidence interval (CI), 84.4-1850.8; P < 0.001). The variables that were significantly different between infants with CMD with chylothorax and those without chylothorax were as follows: maternal age (33.0 vs. 24.8; P = 0.005), polyhydramnios (5/5 vs 1/5; P = 0.034), number of CTG repeats (1980 vs. 1500; P = 0.038), duration of invasive mechanical ventilation (220 vs. 2, P = 0.009), and duration of hospitalization (217.2 vs 68.0; P = 0.014). The mortality rate of all eligible infants with CMD was 5/10 (50%). No variables were significantly associated with mortality. CONCLUSIONS The proportion of chylothorax in infants with CMD was significantly higher than that in infants without CMD. Furthermore, the proportion was higher than that reported in previous studies on congenital chylothorax. This suggests that chylothorax may be frequently experienced in the clinical course of CMD.
Collapse
Affiliation(s)
- Masanori Kambara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
| | - Satoshi Ibara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| |
Collapse
|
7
|
Gámez-Varela A, Martínez-Rodríguez M, López-Briones H, Luna-García J, Chávez-González E, Villalobos-Gómez R, Hernandez-Andrade E, Cruz-Martínez R. Preoperative Cervical Length Predicts the Risk of Delivery within One Week after Pleuroamniotic Shunt in Fetuses with Severe Hydrothorax. Fetal Diagn Ther 2021; 48:297-303. [PMID: 33784701 DOI: 10.1159/000514912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. METHODS A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated. RESULTS Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0-36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. CONCLUSION In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.
Collapse
Affiliation(s)
- Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | | | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Medicina Fetal Mexico, Querétaro, Mexico.,Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Querétaro, Mexico
| |
Collapse
|
8
|
Cruz-Martínez R, Sosa Sosa C, Martínez-Rodríguez M, Gámez-Varela A, Villalobos-Gómez R, López-Briones H, Luna-García J, Chávez-González E, Juárez-Martínez I. Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures. Fetal Diagn Ther 2021; 48:209-216. [PMID: 33677452 DOI: 10.1159/000513748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. METHODS A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. RESULTS Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. CONCLUSION In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico, .,Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico, .,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Queretaro, Mexico,
| | - Cristian Sosa Sosa
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara,", Queretaro, Mexico
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Eréndira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| |
Collapse
|
9
|
Tai HL, Mok TYD, Chao AS, Chu SM, Lien R. Staged Management of Congenital Chylothorax With Hydrops Fetalis: An Insight Into EXIT Related Procedures. Front Pediatr 2021; 9:633051. [PMID: 33681104 PMCID: PMC7925828 DOI: 10.3389/fped.2021.633051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Idiopathic congenital chylothorax is a rare but serious disease. Advancement in perinatal care and the renovated treatment modalities have brought about significant improvement in patient outcome. Objective: To describe the clinical course of severe forms of idiopathic congenital chylothorax, focusing on the development of recent treatment modalities and their impacts. Design: A retrospective cohort by review of medical records in the NICU of a perinatal referral center in Taiwan. Study period was from January 2006 to June 2017. Neonates with the diagnosis of idiopathic congenital chylothorax with non-immune hydrops fetalis were enrolled. Clinical relevant including demographic data, perinatal interventions, post-natal course, and treatment outcome were described and analyzed. Results: Twenty-eight neonatal patients were included. The median gestational age at birth was 34 (range 27-36) weeks and median birth weight was 2,369 (range 1,430-3,608) g. Prenatal intervention was performed in 39.3% of the patients. Besides, 11 out of the 28 neonates developed tension pneumothorax in the first 24 h and 4 (36.4%) of them died. Sepsis was documented in two patients (7.1%). Overall survival rate was 71.4%. There were five patients enrolled during the last 2 years of the study period. EXIT with intubation was performed in two and octreotide was given to four of these most recent neonates, and all of them survived. Conclusion: Recent advances in the management of these neonates, specifically EXIT with intubation and use of octreotide. Both of them improved patient survival in our cohort, but the evidence of impact has yet to be validated.
Collapse
Affiliation(s)
- Hung-Lin Tai
- Department of Pediatrics, Saint Paul's Hospital, Taoyuan City, Taiwan.,Division of Neonatalogy, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tze Yee Diane Mok
- Division of Neonatalogy, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Medical Center, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shih-Ming Chu
- Division of Neonatalogy, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Reyin Lien
- Division of Neonatalogy, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| |
Collapse
|
10
|
Congenital Chylothorax with Lymphatic Malformation and Successful Antenatal and Postnatal Management. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
11
|
Fetal intervention for congenital chylothorax is associated with improved outcomes in early life. J Surg Res 2018; 231:361-365. [PMID: 30278954 DOI: 10.1016/j.jss.2018.05.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/21/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Congenital chylothorax (CC) can have devastating consequences for neonates. We sought to determine the outcomes of cases treated at our institution and evaluate the role of fetal intervention. MATERIALS AND METHODS With Institutional Review Board approval, patients treated at our institution 09/2006-04/2016 with CC were reviewed. History and outcomes were compared between patients undergoing fetal intervention (fetal group) and patients who did not (control group). RESULTS Twenty-three patients were identified. Mean gestational age at birth was 35 wk. Overall mortality was 30% (7 patients). Nineteen patients (83%) were prenatally diagnosed, and 10 patients (43%) underwent fetal intervention. Birth weight was significantly lower in the fetal group compared to the control group (median interquartile range [IQR]; 2.5 [2.3-3.0] versus 3.3 [2.6-3.7] kg, P = 0.02). Apgar scores were significantly higher in the fetal group than the control group at 1 and 5 min (median [IQR]; 6 [4-8] versus 1 [1-2], P = 0.005 and 8 [7-9] versus 2 [2-6], P = 0.008, respectively). For those patients with prenatal diagnosis of CC and hydrops fetalis, thrombosis and lymphopenia were both improved in the fetal group (thrombosis 0% versus 40%, P = 0.03; lymphocyte nadir [median {IQR}] 1.5 [0.6-2.9] versus 0.1 [0.05-0.2], P = 0.02). Duration of support with mechanical ventilation was significantly shorter in the fetal group (median [IQR]; 1 [0-40] versus 41 [29-75] d, P = 0.04). CONCLUSIONS Fetal intervention for CC is associated with improved Apgar scores and decreased ventilator days and complications in patients with hydrops fetalis. Fetuses with chylothorax, especially those with hydrops, should be referred to a fetal center for evaluation.
Collapse
|