1
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Tawhai P, van den Boom J, Cama J. Chylothorax associated with a PICC line in a very low birth weight infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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2
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Senarathne UD, Rodrigo R, Dayanath BKTP. Milky pleural effusion in a neonate and approach to investigating chylothorax. BMJ Case Rep 2021; 14:14/9/e245576. [PMID: 34588205 PMCID: PMC8483043 DOI: 10.1136/bcr-2021-245576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared ‘milky’ with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.
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Affiliation(s)
- Udara Dilrukshi Senarathne
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka .,Department of Chemical Pathology, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Ranmali Rodrigo
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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3
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Resch B, Sever Yildiz G, Reiterer F. Congenital Chylothorax of the Newborn: A Systematic Analysis of Published Cases between 1990 and 2018. Respiration 2021; 101:84-96. [PMID: 34515211 DOI: 10.1159/000518217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gülsen Sever Yildiz
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Friedrich Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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4
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Hickmann D, Maiberger T, von der Wense A, Reinshagen K. Erworbener Chylothorax im Säuglingsalter. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
ZusammenfassungEs wird über den Fall eines 8‑monatigen Säuglings mit einem Chylothorax unklarer Genese berichtet. Ein Stridor, zunehmende respiratorische Beeinträchtigung und, bedingt durch den hohen Eiweißverlust, ausgeprägte Ödeme waren die relevantesten klinischen Merkmale. Die bekannten konservativen Therapien wie fettfreie enterale Ernährung unter Substitution von „medium-chain triglycerides“(MCT)-Fetten, gefolgt von Nahrungskarenz und parenteraler Ernährung sowie die Gabe des Somatostatinanalogons Octreotid konnten trotz langer Therapiedauer keine Besserung erzielen. Erst der Einsatz von thorakoskopisch eingebrachten Titan-Clips brachte letztlich den gewünschten Erfolg.
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5
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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.
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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
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6
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Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics. Respir Med Case Rep 2020; 31:101274. [PMID: 33209575 PMCID: PMC7658704 DOI: 10.1016/j.rmcr.2020.101274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.
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7
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Tomobe Y, Mizuguchi U, Shimotakahara A, Shimojima N, Okazaki K. Combination Therapy with Etilefrine and Pleurodesis for Refractory Congenital Chylothorax. Biomed Hub 2020; 5:907-911. [PMID: 33564667 DOI: 10.1159/000509903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Etilefrine, a sympathomimetic agent, is reportedly effective against postoperative chylothorax. However, its effectiveness in treating congenital chylothorax was unknown. We report herein a case of refractory congenital chylothorax treated with etilefrine in a late preterm neonate with massive fetal chylous pleural effusion. The chylothorax was unresponsive to previous treatments, including dietary and pharmacological treatment and thoracic duct ligation. The pleural effusion decreased after intravenous etilefrine was begun on day of life (DOL) 84 and resolved after the addition of chemical pleurodesis with OK-432 on DOL 90. This combination therapy may be a viable treatment option for cases of congenital chylothorax that are unresponsive to other treatments.
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Affiliation(s)
- Yutaro Tomobe
- Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Uiko Mizuguchi
- Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Naoki Shimojima
- Division of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kaoru Okazaki
- Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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8
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Chavhan GB, Lam CZ, Greer MLC, Temple M, Amaral J, Grosse-Wortmann L. Magnetic Resonance Lymphangiography. Radiol Clin North Am 2020; 58:693-706. [PMID: 32471538 DOI: 10.1016/j.rcl.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dynamic contrast-enhanced magnetic resonance lymphangiography is a novel technique to image central conducting lymphatics. It is performed by injecting contrast into groin lymph nodes and following passage of contrast through lymphatic system using T1-weighted MR images. Currently, it has been successfully applied to image and plan treatment of thoracic duct pathologies, lymphatic leaks, and other lymphatic abnormalities such as plastic bronchitis. It is useful in the assessment of chylothorax and chyloperitoneum. Its role in other areas such as intestinal lymphangiectasia and a variety of lymphatic anomalies is likely to increase.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Michael Temple
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Division of Image Guided Therapy (IGT), Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joao Amaral
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Division of Image Guided Therapy (IGT), Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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9
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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]
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10
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Congenital Chylothorax: Common and Uncommon Findings in an Infant with Chylous Effusions. Neonatal Netw 2020; 38:357-364. [PMID: 31712400 DOI: 10.1891/0730-0832.38.6.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/25/2022]
Abstract
Congenital chylothorax is defined as an abnormal accumulation of lymphatic fluid in the pleural space. It is a rare condition in the neonate that causes significant respiratory, nutritional, and immunologic problems resulting in a high mortality rate. Presented here is a case of congenital bilateral chylothorax in a preterm infant. Fetal ultrasound at 33 weeks' gestation showed polyhydramnios, bilateral pleural effusions, ascites, and subcutaneous edema. Fetal pleuracentesis was done on the right side with 118 mL of fluid aspirated. This article addresses the management of this difficult disease process, complications, and implications for research of controversial therapies.
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11
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Sadeghi-Moghadam P, Pourazizi M, Shafieyoon S. Nonchylous bilateral pleural effusion in a newborn: A rare case. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:11. [PMID: 30988679 PMCID: PMC6421884 DOI: 10.4103/jrms.jrms_799_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Mohsen Pourazizi
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Isfahan Eye Research Center, Student's Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shamim Shafieyoon
- Department of pediatric, Student's Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Hermon M, Tenner E, Burda G, Strohmaier W, Schlager G, Golej J. Chylothorax and Chylous-Like Diseases in Children: Clinical Management. Front Pediatr 2019; 7:258. [PMID: 31316953 PMCID: PMC6610320 DOI: 10.3389/fped.2019.00258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/06/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Chylothorax and chylous-like diseases are rare conditions and difficult to treat. But they may represent potentially life-threatening disorders and important causes of morbidity and prolonged hospitalization, especially in critically ill children. Conservative as well as surgical therapeutic management strategies are continuously performed at our institution, however the results have never been evaluated and no guidelines for treatment recommendations have been put into practice so far. The objective of this retrospective study was to present a comprehensive and substantial evaluation of all relevant demographic data from children with the chylothorax and chylous-like diseases and their clinical management. Methods: We retrospectively analyzed data from all children with diagnoses of chylothorax and chylous-like diseases admitted to our pediatric intensive care unit between the years 1999 and 2012. Results: Data of 34 patients were analyzed for this study. Gender distribution (M/F) was almost equal (19/15; 56%/44%). Thirty-one children (91%) developed chylothorax after surgery. Two children (6%) had idiopathic chylothorax and in one child (3%) congenital chylothorax was diagnosed. All study patients (n = 34; 100%) received MBF/MCT therapy. We were quite successful in treating 14 children who received only this therapy, with chest tube output dropping from 100 to 4.7%. But only 11 (32%) children received somatostatin and 7 (20%) children received beta-isodona. Different surgical interventions were performed in 6 patients (17%). All study patients received chest tubes to drain the pleural fluid and hence to relieve the chyle related symptoms. Conclusion: A combination of different conservative therapies was successful in most of our patients. Prevention, early diagnosis and treatment of potential complications may further improve the success rate of conservative therapy especially in patients with postoperative chylothorax. In summary, appropriate therapy of this condition may be lengthy but can prevent significant morbidity and mortality.
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Affiliation(s)
- Michael Hermon
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Elias Tenner
- ENT-Department, Universitätsklinikum St. Pölten, Sankt Pölten, Austria
| | - Gudrun Burda
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Strohmaier
- Institut für Molekulare Biowissenschaften, Karl Franzens University Graz, Graz, Austria
| | - Gerald Schlager
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Johann Golej
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
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13
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Yasuda M, Tetsuhara K, Tsuji S. Point-of-care ultrasound in two neonates with congenital chylothorax and respiratory failure. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Upadia J, Philips JB, Robin NH, Lose EJ, Mikhail FM. A case report of chromosome 17q22-qter trisomy with distinct clinical presentation and review of the literature. Clin Case Rep 2018; 6:612-616. [PMID: 29636925 PMCID: PMC5889218 DOI: 10.1002/ccr3.1298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 11/14/2022] Open
Abstract
Terminal 17q trisomy is very rare but a recognizable genetic syndrome. The majority of cases reported are inherited from a balanced translocation carrier. This syndrome involves many organs and the severity ranges from mild to severe depending on the size of the 17q gain.
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Affiliation(s)
- Jariya Upadia
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
| | - Joseph B Philips
- Department of Pediatrics University of Alabama at Birmingham Birmingham Alabama USA
| | - Nathaniel H Robin
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
| | - Edward J Lose
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
| | - Fady M Mikhail
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
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15
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Nakayama A, Oshiro M, Yamada Y, Hattori T, Wakano Y, Hayashi S, Kokubo M, Takemoto K, Honda S, Ieda K, Yamamoto H, Kouwaki M, Yokoi K, Shinohara O, Kato T, Miyata M, Tanaka T, Hayakawa M. Prognostic factors of hydrops fetalis with pleural effusion. Pediatr Int 2017; 59:1053-1057. [PMID: 28672054 DOI: 10.1111/ped.13357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hydrops fetalis (HF) has a low survival rate, particularly in the case of preterm birth. In addition, the severity index of HF has not been fully investigated yet. The aim of this study was to clarify the prognostic factors of HF with pleural effusion. METHODS All live-born HF patients with pleural effusion, except for chromosomal abnormality or complex congenital heart disease, born from 2009 to 2013 in Aichi Prefecture in Japan were included. Prenatal, perinatal, and postnatal information was obtained from the medical records and was retrospectively analyzed. RESULTS Forty-one HF patients with pleural effusion were included, and 28 patients (68%) survived. On multivariate logistic stepwise analysis, gestational birth week (OR, 0.71; 95% CI: 0.52-0.96, P = 0.027) and standard deviation (SD) score of the birthweight (OR, 1.74; 95% CI: 1.01-2.99, P = 0.045) were significant factors for postnatal death. All patients with both ≥32 gestational weeks and <3.0 birthweight SD score survived. CONCLUSIONS Combined with the gestational weeks data, birthweight SD score may be useful to estimate the prognosis of HF with pleural effusion.
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Affiliation(s)
- Atsushi Nakayama
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Makoto Oshiro
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yasumasa Yamada
- Division of Reproductive and Perinatal Medical Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Tetsuo Hattori
- Department of Neonatology, Anjo Kosei Hospital, Anjo, Japan
| | - Yasuhiro Wakano
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Seiji Hayashi
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Minoru Kokubo
- Department of Pediatrics, Aichi Prefectural Welfare Federation of Agricultural Cooperatives Kainan Hospital, Yatomi, Japan
| | - Koji Takemoto
- Department of Pediatrics, Konan Kosei Hospital, Konan, Japan
| | - Shigeru Honda
- Department of Pediatrics, Komaki City Hospital, Komaki, Japan
| | - Kuniko Ieda
- Department of Pediatrics, Tosei General Hospital, Seto, Japan
| | - Hikaru Yamamoto
- Department of Neonatology, Toyota Memorial Hospital, Toyota, Japan
| | - Masanori Kouwaki
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kyoko Yokoi
- Department of Pediatrics, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Takenori Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masafumi Miyata
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Taihei Tanaka
- Department of Pediatrics, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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16
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Chavhan GB, Amaral JG, Temple M, Itkin M. MR Lymphangiography in Children: Technique and Potential Applications. Radiographics 2017; 37:1775-1790. [DOI: 10.1148/rg.2017170014] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Govind B. Chavhan
- From the Department of Diagnostic Imaging (G.B.C., J.G.A., M.T.) and Division of Image Guided Therapy, Department of Diagnostic Imaging (J.G.A., M.T.), The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Center for Lymphatic Imaging and Interventions, Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Joao G. Amaral
- From the Department of Diagnostic Imaging (G.B.C., J.G.A., M.T.) and Division of Image Guided Therapy, Department of Diagnostic Imaging (J.G.A., M.T.), The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Center for Lymphatic Imaging and Interventions, Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Michael Temple
- From the Department of Diagnostic Imaging (G.B.C., J.G.A., M.T.) and Division of Image Guided Therapy, Department of Diagnostic Imaging (J.G.A., M.T.), The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Center for Lymphatic Imaging and Interventions, Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Maxim Itkin
- From the Department of Diagnostic Imaging (G.B.C., J.G.A., M.T.) and Division of Image Guided Therapy, Department of Diagnostic Imaging (J.G.A., M.T.), The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Center for Lymphatic Imaging and Interventions, Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.I.)
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17
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Cao L, Du Y, Wang L. Fetal pleural effusion and Down syndrome. Intractable Rare Dis Res 2017; 6:158-162. [PMID: 28944136 PMCID: PMC5608924 DOI: 10.5582/irdr.2017.01028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 01/23/2023] Open
Abstract
Fetal pleural effusion is a rare abnormality that results from accumulation of fluid in the chest cavity. It can be classified as primary fetal hydrothorax and secondary fetal hydrothorax. The underlying causes of pleural effusion are still unknown, and the current treatment strategies are mainly based on symptoms. The prognosis of fetal pleural effusion varies significantly, ranging from spontaneous resolution to perinatal death. Recent advances in prenatal diagnostic methods and treatment such as thoracoamniotic shunting have significantly improved the survival rates for patients with or without hydrops.
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Affiliation(s)
- Li Cao
- Ultrasound Department, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Du
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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Trocado V, Coutinho-Borges JP, Carlos-Alves M, Santos J, Pinheiro P. Fetal primary hydrothorax with spontaneous resolution. Case Rep Womens Health 2017; 15:6-7. [PMID: 29593993 PMCID: PMC5842973 DOI: 10.1016/j.crwh.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 04/05/2017] [Accepted: 06/09/2017] [Indexed: 11/30/2022] Open
Abstract
Fetal primary hydrothorax is a rare congenital anomaly with an estimated incidence of 1:10.000–15.000 pregnancies, with an unpredictable clinical course, ranging from spontaneous resolution to fetal death. We present a case of a unilateral fetal pleural effusion identified at 35th gestational week. A 37 year-old woman (G2P1) presented to our routine term pregnancy evaluation. The pregnancy had been otherwise uneventful. At ecographic evaluation a large anechogenic fluid collection was identified in the right fetal hemithorax, with atelectasis of right lung, displacing the heart and mediastinal structures to the contralateral hemithorax. Hydramnios was also identified. No other structural abnormalities were detected, as no signs of hydrops. Fetal biometry was compatible with gestational age. Fetal ecochardiogram was structurally and functionally normal. Doppler evaluation of the peak systolic velocity in the middle cerebral artery was normal. Screening for congenital infections was negative. Complete blood cell count, blood type and antibody screening rulled-out immune hydrops. Karyotype analysis was not performed as family decision. Serial ecographic re-evaluations showed a progressive volume decrease and at the 38th week there was total resolution of the effusion. A C-section was performed at the 39th week. A live female infant was born weighing 3205 g, with no need of ventilatory support. One year post-partum follow-up evaluation confirmed the child was healthy. Spontaneous regression has been reported to occur in 9–22% of primary fetal hydrothoraxes, but the features predicting a better prognosis remain difficult to define. Unilateral effusion, spontaneous resolution and absence of hydrops at the age of diagnosis seem to be indicators of better outcome. Fetal primary hydrothorax is a rare congenital anomaly, generally a diagnosis of exclusion. It has an unpredictable clinical course ranging from spontaneous resolution to fetal death. Unilateral effusion, absence of hydrops or hydramnios at the age of diagnosis seem to be indicators of a good prognosis.
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Affiliation(s)
- Vera Trocado
- Department of Obstetrics and Gynecology, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - J P Coutinho-Borges
- Department of Obstetrics and Gynecology, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Mariana Carlos-Alves
- Department of Obstetrics and Gynecology, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Joaquim Santos
- Department of Obstetrics and Gynecology, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Paula Pinheiro
- Department of Obstetrics and Gynecology, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
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Lee CJ, Tsao PN, Chen CY, Hsieh WS, Liou JY, Chou HC. Prenatal Therapy Improves the Survival of Premature Infants with Congenital Chylothorax. Pediatr Neonatol 2016; 57:127-32. [PMID: 26315047 DOI: 10.1016/j.pedneo.2015.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/30/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chylothorax is a rare condition among neonates, although it is considered clinically significant, as it is difficult to manage in these patients. In addition, the course of chylothorax varies widely. Therefore, we aimed to elucidate the clinical features and effect of prenatal therapy on the prognosis of congenital chylothorax in neonates. METHODS We retrospectively reviewed the medical records of all infants with congenital chylothorax who were admitted to National Taiwan University Hospital, Taipei, Taiwan between January 2000 and December 2012. Their demographic characteristics, as well as their antenatal, perinatal, and postnatal information, were collected for our analysis of the mortality risk. RESULTS We found 29 infants who were diagnosed with congenital chylothorax during the study period. The median gestational age at birth was 34 weeks (range, 28-41 weeks), and 71% of the infants presented with hydrops fetalis. Most cases of congenital chylothorax were bilateral (bilateral: 86.2%, unilateral: 13.79%), and the overall survival rate was 59.6%. Among the cases with a prenatal diagnosis at ≤ 34 weeks of gestation, infants who received prenatal therapy had a significantly higher survival rate, compared to infants who did not receive prenatal therapy (76.9% vs. 11%, respectively; p = 0.008). CONCLUSION We found that infants whose chylothorax was diagnosed ≤ 34 weeks of gestation, and who subsequently received prenatal therapy, experienced a better perinatal condition and exhibited improved postnatal outcomes.
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Affiliation(s)
- Chia-Jung Lee
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan
| | - Jyun-You Liou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, Medical College, Taipei, Taiwan.
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Gargano G, Paltrinieri AL, Gallo C, Di Pancrazio L, Roversi MF, Ferrari F. Massive thymic hemorrhage and hemothorax occurring in utero. Ital J Pediatr 2015; 41:88. [PMID: 26568429 PMCID: PMC4644340 DOI: 10.1186/s13052-015-0196-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality. CASE PRESENTATION We report a case of spontaneous massive thymic haemorrhage in a newborn developing at birth acute respiratory distress associated with severe bilateral haemothorax. Thymic enlargement was evident after pleural evacuation and confirmed by radiographic, Computed Tomography (CT) images and Magnetic Resonance Imaging (MRI) sequences. The spontaneous resolution of this enlargement seen with CT scan and MRI sequences suggested a thymic haemorrhage; surgery was not necessary. CONCLUSION Thymic haemorrhage should be considered in newborn infants with pleural effusion, mediastinal space enlargement and Respiratory Distress.
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Affiliation(s)
- Giancarlo Gargano
- Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), Arcispedale S. Maria Nuova, Istituto Tecnologie Avanzate e Modelli Assistenziali in Oncologia-IRCCS, Viale Risorgimento n. 70, 42100, Reggio Emilia, Italy.
| | - Anna Lucia Paltrinieri
- Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), Arcispedale S. Maria Nuova, Istituto Tecnologie Avanzate e Modelli Assistenziali in Oncologia-IRCCS, Viale Risorgimento n. 70, 42100, Reggio Emilia, Italy.
| | - Claudio Gallo
- Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), Arcispedale S. Maria Nuova, Istituto Tecnologie Avanzate e Modelli Assistenziali in Oncologia-IRCCS, Viale Risorgimento n. 70, 42100, Reggio Emilia, Italy.
| | | | - Maria Federica Roversi
- Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), University Hospital, Modena, Italy.
| | - Fabrizio Ferrari
- Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), University Hospital, Modena, Italy.
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Congenital chylothorax treated with oral sildenafil: a case report and review of the literature. J Perinatol 2015; 35:384-6. [PMID: 25917021 DOI: 10.1038/jp.2015.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/23/2015] [Indexed: 11/08/2022]
Abstract
Congenital chylothorax (CC) can result from a congenital malformation or an acquired obstruction or disruption of the thoracic duct. Recently, oral administration of the phosphodiesterase-5 inhibitor, sildenafil, was reported to be effective in resolving non-pulmonary lymphatic malformations in infants and young children. We report a case of CC in a late preterm infant with congenital pulmonary lymphangiectasia where octreotide was not effective, but management with oral sildenafil was successful.
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Bialkowski A, Poets CF, Franz AR. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed 2015; 100:F169-72. [PMID: 25480460 DOI: 10.1136/archdischild-2014-307274] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Congenital chylothorax (CCT) is a rare disease of unknown aetiology. Treatment approaches vary; none has been evaluated prospectively. OBJECTIVE To prospectively determine incidence, treatment and outcome of infants with CCT born in Germany in 2012. DESIGN CCT was defined as non-traumatic chylous pleural effusion within 28 days after birth. As part of the Surveillance Unit for Rare Pediatric Conditions in Germany (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland), all paediatric departments (n=432) received monthly reporting cards to notify the study centre of CCT cases, which were analysed based on anonymised questionnaires and discharge summaries. Data are shown as median (range) or n/N. RESULTS Of 37 cases reported, 28 met inclusion criteria. Questionnaires and/or discharge summaries were available for 27/28. Assuming complete reporting, the incidence of CCT was 1:24 000. Nine infants suffered from proven or suspected syndromal anomalies, most frequently Noonan syndrome (5/9). Postnatally, 23 required mechanical ventilation, 3 continuous positive airway pressure; only 1 had no respiratory support. 17 infants were treated with inotropes/vasopressors, 25 required pleural drainage for 11 (1-36) days. In 13 infants, enteral feeds were withheld initially; 25 received medium-chain triglyceride diet at some time, 9 were treated with octreotide or somatostatin. 18 infants survived without, 6 with sequelae attributable to the underlying disorder; 3 infants died (median age at death 37 (2-144) days). Duration of hospital stay in survivors was 51 (20-127) days. Infants treated with octreotide or somatostatin had similar outcomes compared with those not treated. CONCLUSIONS Based on this small observational study, CCT seems to have a favourable prognosis if not associated with genetic disorders.
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Affiliation(s)
- Anja Bialkowski
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany Center for Pediatric Clinical Studies, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
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Rork JF, Alomari AI, Mulliken JB, Fishman SJ, Liang MG. Diffuse capillary malformation in association with fetal pleural effusion: report of five patients. Pediatr Dermatol 2015; 32:70-5. [PMID: 25644040 DOI: 10.1111/pde.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Capillary malformation (CM) can be a "red flag" for several syndromic vascular anomalies. We identified a subset of patients with diffuse CM and fetal pleural effusion and documented the type of CM, the etiology of the pleural effusion, the potential syndromic diagnosis, and outcome. Patients with a history of CM and fetal pleural effusion were identified by searching the database of patients evaluated at the Vascular Anomalies Center at Boston Children's Hospital. Standardized patient interviews and a retrospective review of records, photographs, and imaging studies were conducted. Five patients had diffuse CM and fetal pleural effusion. Two patients had macrocephaly-CM (M-CM), one had features of M-CM and CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and spinal/skeletal anomalies and/or scoliosis), and one had diffuse CM with overgrowth. The pleural fluid was chylous in four patients. One patient had thoracic lymphatic malformation. Recurrent effusion occurred in one patient coincident with pneumonia at age 11 years. Four patients had a history of reactive airway disease and episodic pulmonary infections. The diagnosis of vascular anomaly-overgrowth syndromes, particularly M-CM, should be considered in neonates with fetal pleural effusion.
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Affiliation(s)
- Jillian F Rork
- Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
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25
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Abstract
OBJECTIVES To investigate the clinical course and mid-term prognosis of neonates admitted with pleural effusion. METHODS Case records of 38 neonates admitted with pleural effusion were retrieved and analyzed. RESULTS 16 (42%) patients had congenital and 22 (58%) patients had acquired causes of pleural effusion. The most common causes of congenital pleural effusion and acquired pleural effusion were chylothorax (18%) and congestive heart failure (13%), respectively. Poorer outcome was observed with fetal hydrops, preterm birth (<34 weeks) and associated defects. CONCLUSION Most of the neonates with pleural effusion have good outcome in the mid-term follow-up.
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Affiliation(s)
- Lai Shuan Wang
- Departments of Neonatology and *Gynecology, Fudan University, Shanghai , China. Correspondence to: Wenhao Zhou, Department of Neonatology, Childrens Hospital of Fudan University, 399 Wanyuan Road, Shanghai, China.
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Abstract
Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center; Le Bonheur Children's Hospital; and St. Jude Children's Research Hospital, Memphis, Tennessee
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Downie L, Sasi A, Malhotra A. Congenital chylothorax: associations and neonatal outcomes. J Paediatr Child Health 2014; 50:234-8. [PMID: 24372911 DOI: 10.1111/jpc.12477] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 12/01/2022]
Abstract
AIM Congenital chylothorax is a rare but significant neonatal entity with major morbidity and mortality. The study aims to describe the related associations, management and outcomes of this condition in neonates. METHODS This is a retrospective case series of all cases of congenital chylothorax admitted to a tertiary neonatal centre in the last 15 years. RESULTS Ten cases of congenital chylothorax were identified. Eight infants were diagnosed antenatally and three infants had antenatal pleural drainage. Most infants were ventilated at birth and required immediate pleurocentesis. Post-natal management included drainage of fluid, ventilation, albumin replacement, octreotide and dietary modification with medium-chain triglyceride-enriched formula. Five infants had chromosomal aberrations identified, while a further two had dysmorphic features not substantiated with routine genetic testing. Noonan's syndrome was the single most common underlying genetic diagnosis. Associated anomalies and malformations were present in 80% of the cohort. There were two deaths in the series, both in infants with multiple co-morbidities. CONCLUSIONS Congenital chylothorax is a rare condition with overall prevalence of less than a case per year in our experience. Majority of infants had associated chromosomal anomalies and significant co-morbidities needing prolonged intensive care.
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Affiliation(s)
- Lilian Downie
- Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia
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Ramesh BY, Kumar N. Isolated bilateral severe fetal hydrothorax: complete resolution following a single postnatal thoracocentesis. Indian J Pediatr 2012; 79:392-4. [PMID: 21706243 DOI: 10.1007/s12098-011-0502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 06/10/2011] [Indexed: 02/05/2023]
Abstract
Isolated pleural effusion is a rare condition in a fetus or neonate with high mortality. When there are no other findings of hydrops fetalis or documented etiology such as inflammatory, iatrogenic or cardiac problems exist, isolated pleural effusion is considered. Timely diagnosis and management not only avoids mortality but also results in excellent prognosis. For fetal hydrothorax, intrauterine management is usually recommended. For those who present late, postnatal management includes intubation, thoracocentesis, ventilation and supportive care. The authors present isolated bilateral severe hydrothorax in a preterm neonate that resulted in severe respiratory compromise at birth. A single postnatal thoracocentesis resulted in complete resolution. No definite etiology for hydrothorax could be established. He had normal growth and development during his follow up till 1 year of age.
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Affiliation(s)
- Bhat Y Ramesh
- Department of Pediatrics, Kasturba Medical College, Manipal University, Udupi District, Manipal, 576104 Karnataka, India.
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Consigli C, Tempera A, Alegiani C, Spinelli M, Scapillati E, Haass C, Finocchi M, Luca E, Stival E, De Luca D, Piastra M. Ventilation mode and outcome of premature infants with congenital chylothorax. J Matern Fetal Neonatal Med 2012; 25:1627-30. [PMID: 22185327 DOI: 10.3109/14767058.2011.648246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Congenital chylothorax (CC) is a rare and potentially life-threatening condition. Over 50% occurs at birth and is considered as the most common cause of neonatal thoracic fluid collection. OBJECTIVES To analyse the main clinical and respiratory features of a contemporary group of CC infants. METHODS Databases for CC diagnosed between 2004 and 2009 were reviewed: 10 consecutive cases were retrieved and analysed. RESULTS Median gestational age of CC patients was 31.8 weeks. Most patients were diagnosed prenatally (7/10 pts, median GA at diagnosis 28 weeks). Severe respiratory distress at birth required respiratory support: 7/10 newborns received high-frequency oscillatory ventilation (HFOV) electively. Large effusions and/or early-onset pneumothorax did not influence the outcome, while prematurity did not impact significantly on mortality (death rate <33 weeks: 28%). The overall ICU survival rate was 70%. CONCLUSION CC still carries a significant risk of perinatal mortality. Continuous advances in foetal/neonatal medicine and intensive care have considerably improved the prognosis in the last decades, mostly in critically ill infants. HFOV improves lung opening and volume maintenance, possibly shortening the lymph flow over time. It can play a fundamental role both to prevent hypoxic and chronic lung damage and to improve lung recruitment in neonates born with CC.
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Affiliation(s)
- C Consigli
- Neonatal Intensive Care Unit, “S. Pietro Fatebenefratelli” Hospital, Rome, Italy
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Common etiologies of neonatal pleural effusion. Pediatr Neonatol 2011; 52:251-5. [PMID: 22036219 DOI: 10.1016/j.pedneo.2011.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 09/13/2010] [Accepted: 09/17/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pleural effusion is rare and includes several disease entities in the neonatal period. The aim of this study was to investigate the etiology, management, and outcome of neonatal pleural effusions. METHODS We retrospectively collected all neonates who were admitted to the neonatal intensive care unit of Chung Shan Medical University Hospital, Taichung, Taiwan, with discharge diagnosis of pleural effusion, chylothorax, hydrothorax, hemothorax, and empyema, from January 1999 to December 2009. The characteristics, etiology, management, and outcome were analyzed. RESULTS There were 21 patients identified, 16 males (76%) and 5 females (24%). Eight patients (38%) had primary and 13 patients (62%) had secondary etiologies. The etiologies included four parapneumonic effusions or empyema (19%); nine chylothorax (42.8%) with four congenital and five iatrogenic after thoracic surgery; three percutaneously inserted central venous catheter extravasation (14%); one umbilical venous catheter extravasation (4.7%); three hydrops fetalis (14%); and one congestive heart failure (4.7%). Fifteen patients (71%) needed chest tube placement. Conservative management with complete cessation of enteral feedings and use of total parenteral nutrition followed with infant formula containing medium-chain triglyceride was successful in six of the patients (67%) with chylothorax. There were two patients (22%) with chylothorax who received somatostatin administration; one was successful and the other one failed. Thoracic duct ligation was performed uneventfully in two patients with acquired chylothorax. There were three mortalities (14.3%) in this study, which were related to causes other than pleural effusion. CONCLUSIONS Pleural effusions in the neonatal stage may result from chylothorax, hydrops fetalis, extravasation of percutaneously inserted central venous catheter, parapneumonic effusion, congestive heart failure, or other less frequently occurring conditions. Diagnostic chest tap is required for subsequent management. Good outcome is the rule except in hydrops fetalis, which carries high mortality rate.
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31
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Octreotid zur Chylothoraxtherapie bei 2 Frühgeborenen. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-010-2358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singh J, Gathwala G, Rattan KN, Bhalla K. Nonchylous idiopathic pleural effusion in the newborn. Indian J Crit Care Med 2011; 15:46-8. [PMID: 21633547 PMCID: PMC3097543 DOI: 10.4103/0972-5229.78226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital isolated pleural effusion is a rare cause of respiratory distress in neonates. It is usually chylous. Herein, we report a rare case of nonchylous congenital idiopathic pleural effusion.
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Caserío S, Gallego C, Martin P, Moral MT, Pallás CR, Galindo A. Congenital chylothorax: from foetal life to adolescence. Acta Paediatr 2010; 99:1571-7. [PMID: 20528795 DOI: 10.1111/j.1651-2227.2010.01884.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To analyse the main prenatal and postnatal features of congenital chylothorax (CC), and the outcome including mid-term follow-up. METHODS We searched our databases for CC diagnosed between 1990 and 2006. Data of 29 cases were retrieved and analysed. Follow-up until 3 years of age was available for all patients. RESULTS Most patients were diagnosed prenatally (94%) and most cases were complicated by foetal hydrops (66.7%). The overall survival rate at 3 years was 56%. A significantly poorer outcome was observed when foetal hydrops, preterm birth < 34 weeks, large effusions and/or early-onset pneumothorax were present. An important but not significant improvement in the survival rate was observed through the study period; while in 1990-1998, the survival rate was 41.7%, from 1999 to 2006 it was 66.7% (p = 0.19). In the mid-term follow-up, we did not observe any recurrence of CC and most infants remain asymptomatic. However, 27% of survivors were diagnosed as having asthma in early infancy. CONCLUSION CC still carries a significant risk of perinatal mortality. However, continuous advances in foetal and neonatal medicine are improving the prognosis of these patients, and nowadays most of them are likely to survive. Beyond the neonatal period, most survivors have an uneventful outcome.
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Affiliation(s)
- S Caserío
- Department of Pediatrics, Hospital Universitario "12 de Octubre", Madrid, Spain.
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Affiliation(s)
- L Donato
- Pôle Médico-Chirurgical de Pédiatrie, Hôpitaux Universitaires de Strasbourg, France.
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Abstract
Chylothorax is the accumulation of chyle in the pleural space, as a result of damage to the thoracic duct. Chyle is milky fluid enriched with fat secreted from the intestinal cells and lymphatic fluid. Chylothorax in children, is most commonly seen as a complication of cardiothoracic surgery but may occur in newborns or conditions associated with abnormal lymphatics. The diagnosis is based on biochemical analysis of the pleural fluid, which contains chylomicrons, high levels of triglycerides and lymphocytes. Investigations to outline the lymphatic channels can prove helpful in some cases. Initial treatment consists of drainage, dietary modifications, total parenteral nutrition and time for the thoracic duct to heal. Somatostatin and its analogue octreotide may be useful in some cases. Surgery should be considered for patients who fail these initial steps, or in whom complications such as electrolyte and fluid imbalance, malnutrition or immunodeficiency persist. Surgical intervention may be attempted thoracoscopically with repair or ligation of the thoracic duct.
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Affiliation(s)
- Manuel Soto-Martinez
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Parkville, Melbourne, Victoria 3052, Australia.
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36
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Ergaz Z, Bar-Oz B, Yatsiv I, Arad I. Congenital chylothorax: clinical course and prognostic significance. Pediatr Pulmonol 2009; 44:806-11. [PMID: 19598277 DOI: 10.1002/ppul.21070] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the underlying etiology, associated malformations, clinical course, and prognostic significance of congenital chylothorax. STUDY DESIGN A retrospective analysis of 11 neonates admitted to our neonatal intensive care unit with congenital chylothorax between January 2000 and June 2008. The post-discharge clinical and developmental course was evaluated by a telephone survey performed in July 2008. RESULTS Antenatal diagnosis was established in 9 out of 11 infants by ultrasound examination; 5 had intrauterine pleural drainage. Eight infants had either structural or chromosomal abnormalities. The postnatal treatment included mechanical ventilation, drainage of pleural fluid and feeding with enriched medium chain triglyceride formula. Somatostatin was administered in one case. Six patients developed nosocomial infections. Two patients died after resolution of the chylothorax from deteriorating renal failure. Seven patients were traced for follow up and six of them achieved age appropriate developmental milestones. CONCLUSION The recovery from chylothorax and future prognosis were dependent on the underlying etiology. Chylothorax was often a secondary event, with apparently favorable clinical and developmental prognosis when the underlying or/and associated condition was treatable.
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Affiliation(s)
- Zivanit Ergaz
- Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Arafa A, Peitsidis P, Kadir RA. Unusual case of congenital chylothorax. J OBSTET GYNAECOL 2009; 29:59-60. [PMID: 19280501 DOI: 10.1080/01443610802484062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A Arafa
- Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Trust, London, UK
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Been JV, Degraeuwe PLJ. Pleural effusion due to intra-abdominal extravasation of parenteral nutrition. Pediatr Pulmonol 2008; 43:1033-5. [PMID: 18729152 DOI: 10.1002/ppul.20891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An 8-week-old preterm boy experienced respiratory deterioration due to unilateral pleural effusion. Intra-abdominal extravasation of parenteral fluid with leakage into the pleural cavity was suspected based on biochemical analysis of the effluent. Perforation of the central venous catheter in the peritoneal cavity was subsequently confirmed by contrast roentgenography. As in peritoneal dialysis and hepatic hydrothorax, pleuroperitoneal communication needs to be considered in patients exhibiting pleural effusion with a central venous line below the diaphragm.
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Affiliation(s)
- Jasper V Been
- Department of Paediatrics, Maastricht University Hospital, Maastricht, The Netherlands.
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Copons Fernández C, Benítez Segura I, Castillo Salinas F, Salcedo Abizanda S. Quilotórax neonatal: etiología, evolución y respuesta al tratamiento. An Pediatr (Barc) 2008; 68:224-31. [DOI: 10.1157/13116701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Difficulty breathing is a common presenting complaint for infants in the emergency department (ED). Periodic breathing, respiratory or systemic infection, and congenital heart disease are common diagnoses in this age group. We report the case of a male neonate presenting to the ED on multiple occasions with respiratory distress and recurrent pleural effusions of unique origin. Unlike adult pleural effusions, pediatric effusions are most commonly exudative and of infectious origin. In neonates, acquired chylothorax secondary to surgery or trauma is the most common cause of symptomatic pleural effusions. Congenital chylothorax is a rare entity that has not been presented in the emergency medicine literature. This case illustrates the extremely rare ED presentation of congenital chylothorax and outlines an approach to pediatric pleural effusions.
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de Bruijn D, van Oort A, Kapusta L. Ebstein's anomaly with severe hypoplastic and stenotic pulmonary venous connections: an unusual cause of congenital chylothorax. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:910-912. [PMID: 17932998 DOI: 10.1002/uog.5144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
PURPOSE OF REVIEW This review highlights the pathophysiological mechanisms, incidence, clinical features, as well as the diagnosis and treatment of pleural effusions in the neonate. RECENT FINDINGS Pleural effusions are rare except in hydropic neonates. Elevated pleural fluid/serum immunoglobulin G ratio may be a diagnostic marker for congenital chylothorax in utero. Chylothorax may be congenital or acquired. Hydrothoraces may appear at any time during the neonatal period and are related to infectious and noninfectious aetiologies. Haemothorax is defined as the presence of blood in the pleural space. Parenteral nutrition leakage may occur in a newborn with a venous central catheter leading to an effusion that looks like a chylothorax. The value of elevated pleural fluid N-terminal pro-brain natriuretic peptide levels as a marker of congestive heart failure is not yet established in neonates. More recently, in cases of chylothorax that did not resolve with drainage and bowel rest, the use of somatostatin or its analogue octreotide has been described with success. If conservative management fails after 5 weeks, surgical intervention is indicated. SUMMARY Clinicians must be aware of the wide range of disorders causing pleural effusions, the different types and clinical presentations, differential diagnosis, and how to treat each specific case.
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Affiliation(s)
- Gustavo Rocha
- Division of Neonatology, Department of Paediatrics, São João Hospital, Porto, Portugal.
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