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Reddy SV, Sinha SP. Lymphatic Interventions in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:343-354. [PMID: 38839168 DOI: 10.1016/j.iccl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Lymphatic disorders in congenital heart disease can be broadly classified into chest compartment, abdominal compartment, or multicompartment disorders. Heavily T2-weighted noninvasive lymphatic imaging (for anatomy) and invasive dynamic contrast magnetic resonance lymphangiography (for flow) have become the main diagnostic modalities of choice to identify the cause of lymphatic disorders. Selective lymphatic duct embolization (SLDE) has largely replaced total thoracic duct embolization as the main lymphatic therapeutic procedure. Recurrence of symptoms needing repeat interventions is more common in patients who underwent SLDE. Novel surgical and transcatheter thoracic duct decompression strategies are promising, but long-term follow-up is critical and eagerly awaited.
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Affiliation(s)
- Surendranath Veeram Reddy
- Childrens/UT Southwestern Medical Center, Heart Center, B 405, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Sanjay Prakash Sinha
- CHOC/CS Cardiology, UC Irvine School of Medicine, UCLA Mattel Children's Hospital.
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2
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Hirano K, Nakae K, Matsunaga M, Ueno K, Okamoto Y. Successful Treatment of Congenital Chylothorax by Early Use of Prednisolone: A Case Report. Cureus 2024; 16:e60628. [PMID: 38903368 PMCID: PMC11187449 DOI: 10.7759/cureus.60628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/22/2024] Open
Abstract
Congenital chylothorax is the most common form of pleural effusion during the neonatal period; however, no treatment strategy exists. The pathogenesis and etiology of this disease are not fully understood; hence, several cases are difficult to treat. Some patients with chylothorax may not survive due to severe respiratory distress. Prednisolone (PSL) is sometimes used to treat congenital chylothorax but is rarely used in the early postnatal period. In this report, we describe a neonate with prenatal pleural effusion who was successfully treated with PSL from day one after requiring endotracheal intubation and ventilator management due to a postnatal diagnosis of chylothorax. The patient was extubated at four days of age, weaned from the ventilator at 10 days of age, and discharged home at 40 days of age after a total of 10 days of administration. Although the mechanism of action of PSL in chylothorax is unknown, and because it is a steroid, side effects such as gastrointestinal perforation and susceptibility to infection should be noted. The present case suggests the utility of early PSL administration for the treatment strategy of congenital chylothorax.
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Affiliation(s)
- Kyoka Hirano
- Pediatrics, Kagoshima University Hospital, Kagoshima, JPN
| | - Koji Nakae
- Pediatrics, Kagoshima University Hospital, Kagoshima, JPN
| | | | - Kentaro Ueno
- Pediatrics, Kagoshima University Hospital, Kagoshima, JPN
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3
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Vanderhorst ER, Avendano RD, Javier MC, Patil U. A 6-day-old Newborn with Sudden Severe Respiratory Distress. Neoreviews 2024; 25:e216-e219. [PMID: 38556502 DOI: 10.1542/neo.25-4-e216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
| | - Rene Diaz Avendano
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Cristina Javier
- Division of Neonatology and Newborn Services, Department of Pediatrics, Icahn School of Medicine, New York, NY
| | - Uday Patil
- Division of Neonatology and Newborn Services, Department of Pediatrics, Icahn School of Medicine, New York, NY
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4
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LaFontaine R, Lyle ANJ, Upadhyay K. Respiratory Distress in a 3-Week-Old Late Preterm Male Neonate. Neoreviews 2024; 25:e220-e223. [PMID: 38556489 DOI: 10.1542/neo.25-3-e220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Rachel LaFontaine
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Allison N J Lyle
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Kirti Upadhyay
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
- Neonatal Intensive Care Unit (NICU) at UW Medical Center-Montlake, Seattle Children's Hospital, University of Washington, Seattle, WA
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5
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LaFontaine R, Lyle ANJ, Upadhyay K. Respiratory Distress in a 3-Week-Old Late Preterm Male Neonate. Neoreviews 2024; 25:e220-e223. [PMID: 38556498 DOI: 10.1542/neo.25-4-e220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Rachel LaFontaine
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Allison N J Lyle
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Kirti Upadhyay
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
- Neonatal Intensive Care Unit (NICU) at UW Medical Center-Montlake, Seattle Children's Hospital, University of Washington, Seattle, WA
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Vanderhorst ER, Avendano RD, Javier MC, Patil U. A 6-day-old Newborn with Sudden Severe Respiratory Distress. Neoreviews 2024; 25:e216-e219. [PMID: 38556490 DOI: 10.1542/neo.25-3-e216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
| | - Rene Diaz Avendano
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Cristina Javier
- Division of Neonatology and Newborn Services, Department of Pediatrics, Icahn School of Medicine, New York, NY
| | - Uday Patil
- Division of Neonatology and Newborn Services, Department of Pediatrics, Icahn School of Medicine, New York, NY
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7
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Zhang RG, Liu YM, Yao ZY, Fang JX, Li Y, Zheng ML, Sun X, Wen SS, Wang XM, Zhuang J, Luo DD, He SR. Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study. Ther Clin Risk Manag 2024; 20:161-168. [PMID: 38476881 PMCID: PMC10929254 DOI: 10.2147/tcrm.s436991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024] Open
Abstract
Background Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood. Objective The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants. Methods This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the occurrence of chylothorax, the patients were divided into a control group (n = 88) and a case group (n = 88). Univariate and multivariate logistic regression were performed to analyse the incidence and influencing factors of chylothorax after congenital heart surgery in infants. Results Between 2016 and 2020, the annual incidence rate fluctuated between 1.55% and 3.17%, and the total incidence of chylothorax was 2.02%. Multivariate logistic regression analysis showed that postoperative albumin (p = 0.041; odds ratio [OR] = 0.095), preoperative mechanical ventilation (p = 0.001; OR = 1.053) and preterm birth (p = 0.002; OR = 5.783) were risk factors for postoperative chylothorax in infants with congenital heart disease. Conclusion The total incidence of chylothorax was 2.02% and the annual incidence rate fluctuated between 1.55% and 3.17% between 2016 and 2020. Premature infants, longer preoperative mechanical ventilation and lower albumin after congenital heart surgery may be risk factors for chylothorax. In addition, infants with chylothorax are inclined to be infected, need more respiratory support, use a chest drainage tube for longer and remain longer in hospital.
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Affiliation(s)
- Rui-Gui Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510260, People’s Republic of China
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yu-Mei Liu
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Zhi-Ye Yao
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Jing-Xuan Fang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Yuan Li
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Man-Li Zheng
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Xin Sun
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Shu-Sheng Wen
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Xi-Meng Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Dan-Dong Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
| | - Shao-Ru He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510260, People’s Republic of China
- Department of Neonatal Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Pediatrics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
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8
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Bhatnagar M, Fisher A, Ramsaroop S, Carter A, Pippard B. Chylothorax: pathophysiology, diagnosis, and management-a comprehensive review. J Thorac Dis 2024; 16:1645-1661. [PMID: 38505027 PMCID: PMC10944732 DOI: 10.21037/jtd-23-1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024]
Abstract
Chylothorax is a rare condition characterized by the accumulation of chyle in the pleural space. While it accounts for a small percentage of pleural effusions, chylothorax can lead to significant morbidity and mortality. This article provides a comprehensive overview of chylothorax, covering its relevant anatomy, aetiology, pathophysiology, clinical features, diagnosis, and management. Injury or disruption to the thoracic duct (which is responsible for chyle transport) leads to the development of chylothorax. This may result from trauma, such as iatrogenic injury during surgery, or non-traumatic causes, including malignancy, lymphatic disorders, and heart failure. Recognition of the underlying cause is essential to tailor management. Clinical presentation varies, with symptoms linked to rate of chyle accumulation and the causative condition. Diagnosis relies on pleural fluid analysis, with demonstration of elevated triglyceride levels (>110 mg/dL) and reduced cholesterol levels (<200 mg/dL) being the key diagnostic criteria employed in clinical practice. Various imaging modalities, including computed tomography (CT) scans and lymphatic-specific investigations, may be utilised to aid identification of the site of chyle leak, as well as determine the likely underlying cause. Chylothorax management is multifaceted, with conservative approaches such as dietary modification and pharmacological interventions often initiated as first-line treatment. Drainage of chylous effusion may be necessary for symptom relief. When conservative methods fail, interventional procedures like thoracic duct ligation or embolization can be considered. Due to the diverse aetiological factors and patient characteristics associated with chylothorax, individualized management strategies are recommended. Nonetheless, management of chylothorax is an evolving field with a paucity of high-quality evidence or standardized guidelines, highlighting the importance of ongoing research and a multidisciplinary approach to optimize individual patient care.
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Affiliation(s)
- Malvika Bhatnagar
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside, UK
| | - Annette Fisher
- Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Sudarshan Ramsaroop
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Alison Carter
- Department of Respiratory Medicine, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Benjamin Pippard
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside, UK
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9
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Zubi ZBH, Abdullah AFB, Helmi MABM, Hasan TH, Ramli N, Ali AAABM, Mohamed MAS. Indications, Measurements, and Complications of Ten Essential Neonatal Procedures. Int J Pediatr 2023; 2023:3241607. [PMID: 37705709 PMCID: PMC10497369 DOI: 10.1155/2023/3241607] [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] [Received: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
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Affiliation(s)
- Zainab Bubakr Hamad Zubi
- Department of Paediatrics, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Ahmad Fadzil Bin Abdullah
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Muhd Alwi Bin Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Taufiq Hidayat Hasan
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Mossad Abdelhak Shaban Mohamed
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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10
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Porcel JM, Bielsa S, Civit C, Aujayeb A, Janssen J, Bodtger U, Fjaellegaard K, Petersen JK, Welch H, Symonds J, Mitchell MA, Grabczak EM, Ellayeh M, Addala D, Wrightson JM, Rahman NM, Munavvar M, Koegelenberg CF, Labarca G, Mei F, Maskell N, Bhatnagar R. Clinical characteristics of chylothorax: results from the International Collaborative Effusion database. ERJ Open Res 2023; 9:00091-2023. [PMID: 37850216 PMCID: PMC10577597 DOI: 10.1183/23120541.00091-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/14/2023] [Indexed: 10/19/2023] Open
Abstract
Background Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features. Methods The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed. Results 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL-1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL-1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L-1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL-1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. Conclusion Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.
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Affiliation(s)
- José M. Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Silvia Bielsa
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Carmen Civit
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare Foundation Trust, Cramlington, UK
| | - Julius Janssen
- Respiratory Department, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Katrine Fjaellegaard
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Jesper Koefod Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark
| | - Hugh Welch
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jenny Symonds
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Michael A. Mitchell
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Mohamed Ellayeh
- Department of Chest Medicine, Mansoura University, Mansoura, Egypt
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dinesh Addala
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John M. Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Mohammed Munavvar
- Respiratory Department, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- University of Central Lancashire, Preston, UK
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Gonzalo Labarca
- Division of Internal Medicine, Complejo Asistencial Dr Víctor Ríos Ruiz, Los Angeles, Chile
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Federico Mei
- Respiratory Disease Unit, Department of Internal Medicine, University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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11
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Singh P, Parida GK, Emerson R, Kumar P, Agrawal K. Small Chyle Leak Localized on Lymphoscintigraphy with Single-Photon Emission Computed Tomography-Computed Tomography. Indian J Nucl Med 2023; 38:188-190. [PMID: 37456199 PMCID: PMC10348508 DOI: 10.4103/ijnm.ijnm_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 07/18/2023] Open
Abstract
Chylothorax refers to the accumulation of triglyceride-rich fluid (chyle) within the pleural space. We described a case of spontaneous chylothorax in an infant. Lymphoscintigraphy was performed with 99 m-Tc sulfur colloid which showed tracer accumulation into thoracic cavity, and single-photon emission computed tomography/CT (SPECT/CT) revealed leak in the thoracic duct at D8 vertebral level as the cause. We, thus, emphasize the role of lymphoscintigraphy with SPECT/CT in identification of cause and guiding the management of chylothorax, especially when surgical treatment is planned.
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Affiliation(s)
- Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ralph Emerson
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pramit Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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12
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Nahlovsky J, Matejek T. Chemical Pleurodesis with Povidone-Iodine in Congenital Chylothorax. Indian J Pediatr 2023; 90:634. [PMID: 36882662 DOI: 10.1007/s12098-023-04526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Jiri Nahlovsky
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - Tomas Matejek
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 50005, Hradec Kralove, Czech Republic.
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13
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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.
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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
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14
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Rose AT, Keene S. Changing populations being treated with ECMO in the neonatal period - who are the others? Semin Fetal Neonatal Med 2022; 27:101402. [PMID: 36414493 DOI: 10.1016/j.siny.2022.101402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extracorporeal life support via extracorporeal membrane oxygenation (ECMO) has served the sickest of neonates for almost 50 years. Naturally, the characteristics of neonates receiving ECMO have changed. Advances in care have averted the need for ECMO for some, while complex cases with uncertain outcomes, previously not eligible for ECMO, are now considered. Characterizing the disease states and outcomes for neonates on ECMO is challenging as many infants do not fall into classic categories, i.e. meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), or congenital diaphragmatic hernia (CDH). Since 2017, over one third of neonatal respiratory ECMO runs reported to the Extracorporeal Life Support Organization Registry are grouped as Other, a catch-all that encompasses those with a diagnosis not included in the classic categories. This review summarizes the historical neonatal ECMO population, reviews advances in therapy and technology impacting neonatal care, and addresses the unknowns in the ever-growing category of Other.
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Affiliation(s)
- Allison T Rose
- Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA.
| | - Sarah Keene
- Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA.
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15
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Kaul A, Fursule A, Shah S. Author's Response to an Unusual Presentation of Spontaneous Chylothorax. Indian J Crit Care Med 2022; 26:1226. [PMID: 36873597 PMCID: PMC9983659 DOI: 10.5005/jp-journals-10071-24345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
How to cite this article: Kaul A, Fursule A, Shah S. Author's Response to an Unusual Presentation of Spontaneous Chylothorax. Indian J Crit Care Med 2022;26(11):1226.
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Affiliation(s)
- Amita Kaul
- Department of Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, Maharashtra, India
| | - Anurag Fursule
- Department of Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, Maharashtra, India
| | - Sachin Shah
- Department of Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, Maharashtra, India
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16
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Wang B, Feng Y, Guo Y, Kan Q, Zou Y, Wu Y, Zheng M, Cheng R. Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China. J Cardiothorac Surg 2022; 17:276. [PMID: 36303149 PMCID: PMC9615329 DOI: 10.1186/s13019-022-02009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/24/2022] [Indexed: 11/14/2022] Open
Abstract
Objective Congenital chylothorax (CC) is an uncommon congenital disease. The objective of this study was to analyze the clinical features, treatment, and outcome of infants with CC in a Chinese tertiary medical center. Methods CC was defined as a non-traumatic pleural effusion with ≥ 80% lymphocytes detected before birth or within 28 days after birth. Clinical data were collected in CC infants discharged from June 2017 to March 2021. Results A total of 24 CC infants were discharged during the study period, accounting for 67% of congenital pleural effusions. The median gestational age at birth was 36+4 weeks (range 29+5–41 weeks) and the birth weight was 3025 g (range 1850–4250 g). Twenty-one infants were diagnosed antenatally. The median gestational age at the time of diagnosis was 30+3 weeks (range 24–36+6 weeks). Nine infants presented with hydrops fetalis; 18 were bilateral. Prenatal interventions were performed in 13 fetuses. Nine infants (38%) had birth asphyxia. Compared with the infants without hydrops fetalis, the infants with CC and hydrops fetalis had lower Apgar scores at 1 and 5 min (P < 0.05) and a lower gestational age at birth (P < 0.05). Postnatally, 17 infants required continuous pleural drainage for 10 days (range 2–30 days). Analysis of the pleural effusion showed a higher cell count, lymphocyte fraction, and protein content after enteral feeding (P < 0.05). Fifteen infants required mechanical ventilation; 9 did not require any respiratory support. Ten infants received a delayed feeding strategy and 17 received a medium-chain triglyceride (MCT) formula. Only 1 infant received octreotide therapy. Twenty-one infants survived and 3 died. The main cause of death was pulmonary dysplasia. The duration of hospital stay in survivors was 21.5 days (range 10–43) days. For infants with CC and hydrops fetalis, prenatal therapy shortened the duration of pleural drainage and the length of hospital stay (P < 0.05). Conclusion CC is the most common cause of congenital pleural effusions. The poor prognosis is mainly associated with prematurity, hydrops fetalis, and pulmonary dysplasia. Prenatal intervention may improve the outcome of infants with hydrops fetalis.
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Affiliation(s)
- Beibei Wang
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yun Feng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yan Guo
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Qing Kan
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yunsu Zou
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Yue Wu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China.
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17
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Heym KM, Masand PM, Margolin JF. How we approach the diagnosis of a vascular anomaly. Pediatr Blood Cancer 2022; 69 Suppl 3:e29802. [PMID: 35709330 DOI: 10.1002/pbc.29802] [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: 12/17/2021] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022]
Abstract
Vascular anomalies represent a diverse group of complex disorders that can cause significant complications, including coagulopathies, pain, and decreased function. The diagnosis of vascular anomalies is often challenging due to heterogeneity of presenting phenotypes and overlapping clinical features with other pediatric conditions. Pediatric hematologists/oncologists (PHO) are uniquely positioned for an essential role in diagnosing, managing, and coordinating the multidisciplinary care required to maximize the quality of life of these patients. Here, we review the diagnostic approach involved in patients with vascular anomalies and utilize cases to highlight the challenges involved, and how PHOs can play a vital part in the care of these patients.
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Affiliation(s)
- Kenneth M Heym
- Department of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Prakash M Masand
- Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Judith F Margolin
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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18
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Resch B. Management of Congenital Chylothorax of the Newborn. Respiration 2022; 101:795-796. [PMID: 35724638 PMCID: PMC9533427 DOI: 10.1159/000525377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
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
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19
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Samanidis G, Kourelis G, Bounta S, Kanakis M. Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery-Current Aspects in Diagnosis and Treatment. Nutrients 2022; 14:nu14091803. [PMID: 35565771 PMCID: PMC9104302 DOI: 10.3390/nu14091803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022] Open
Abstract
Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction and dysfunction of the right ventricle. In this review, we focus on the existing evidence regarding the definition and diagnosis of postoperative chylothorax in children with CHD, as well as current therapeutic approaches, both nutritional and interventional, for the management of these patients. As part of nutritional management, we specifically comment on the use of defatted human milk and its effect on both chylothorax resolution and patient growth. A consensus with regard to several key aspects of this potentially significant complication is warranted given its impact on the cost, morbidity and mortality of children with CHD.
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Affiliation(s)
- Georgios Samanidis
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Department of Pediatric and Adult Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
- Correspondence:
| | - Georgios Kourelis
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.K.); (S.B.)
| | - Stavroula Bounta
- Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.K.); (S.B.)
| | - Meletios Kanakis
- Department of Pediatric and Adult Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
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20
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Lamouroux A, Dauge C, Wells C, Mousty E, Pinson L, Cave H, Capri Y, Faure JM, Grosjean F, Sauvestre F, Attié-Bitach T, Pelluard F, Geneviève D. Extending the prenatal Noonan's phenotype by review of ultrasound and autopsy data. Prenat Diagn 2022; 42:574-582. [PMID: 35278234 DOI: 10.1002/pd.6133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The antenatal phenotypic spectrum of Noonan Syndrome (NS) requires better characterization. METHODS This multicenter retrospective observational included 16 fetuses with molecularly confirmed NS admitted for fetopathological examination between 2009 and 2016. RESULTS Among 12 pathogenic variants (PV) in PTPN11 (80%), 5 (42%) fell between position c.179 and c.182. Ultrasound showed increased nuchal translucency (n=13/16, 93%), increased nuchal fold after 15 weeks of gestation (n=12/16, 75%), pleural effusions (n=11/16, 69%), polyhydramnios (n=9/16, 56%), hydrops (n=7/16, 44%), cardiovascular (n=6/16, 38%) and cerebral (n=4/16, 25%) anomalies. Fetopathological examination found dysmorphic features in all cases, cardiovascular anomalies (n=12/15, 80%), pulmonary hypoplasia (n=10/15, 67%), effusions (n=7/15, 47%) and neuropathological anomalies (n=5/15, 33%). Hydrops was significantly (p=0.02) more frequent in the four fetuses with RIT1, NRAS and RAF1 PV versus the 12 fetuses with PTPN11 PV. CONCLUSIONS Increased nuchal translucency and nuchal fold is common in NS. NS antenatal phenotype showed high in utero fetal death, hydrops, prenatal pleural effusion and pulmonary hypoplasia, although the inclusion of only deceased fetuses will have selected more severe phenotypes. Non-specific cardiovascular and neurological abnormalities should be added to NS antenatal phenotype. Next generation sequencing will help detect more genotypes, clarifying the prenatal phenotype and identifying genotype-phenotype correlations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Lamouroux
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France.,Obstetrical Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France.,Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF user facility imaging, University of Montpellier, CNRS, Montpellier, France.,ICAR research team, University of Montpellier, CNRS, LIRMM, Montpellier, France
| | - Coralie Dauge
- Pathology Department, University Hospital, Normandy University, Caen, France
| | - Constance Wells
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Eve Mousty
- Obstetrical Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Lucile Pinson
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Hélène Cave
- INSERM UMR_S1131, Institut de Recherche Saint-Louis, Paris University, France.,Genetic Department, molecular genetic unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Paris, France
| | - Yline Capri
- Genetic Department, molecular genetic unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Paris, France.,Inserm UMR_1195 University Paris-Saclay
| | - Jean-Michel Faure
- Obstetrical Gynecology Department, Prenatal diagnosis unit, University hospital Montpellier, University of Montpellier, Montpellier, France
| | - Frédéric Grosjean
- Obstetrical Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Fanny Sauvestre
- Fetopathology Unit, Pathology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Fanny Pelluard
- Fetopathology Unit, Pathology Department, Bordeaux University Hospital, Bordeaux, France.,Univ Bordeaux, INSERM, BaRITOn, U1053, F-33000 Bordeaux, France
| | - David Geneviève
- Clinical Genetics Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
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21
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Wang J, Wei H, Chen H, Wan K, Mao R, Xiao P, Chang X. Application of ultrasonography in neonatal lung disease: An updated review. Front Pediatr 2022; 10:1020437. [PMID: 36389379 PMCID: PMC9640768 DOI: 10.3389/fped.2022.1020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Lung disease is often life-threatening for both preterm and term newborns. Therefore, an accurate and rapid diagnosis of lung diseases in newborns is crucial, as management strategies differ with different etiologies. To reduce the risk of radiation exposure derived from the conventionally used chest x-ray as well as computed tomography scans, lung ultrasonography (LUS) has been introduced in clinical practice to identify and differentiate neonatal lung diseases because of its radiation-free characteristic, convenience, high accuracy, and low cost. In recent years, it has been proved that LUS exhibits high sensitivity and specificity for identifying various neonatal lung diseases. Here, we offer an updated review of the applications of LUS in neonatal lung diseases based on the reports published in recent years (2017 to present).
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hongjuan Wei
- Department of Neonatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Ke Wan
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruifeng Mao
- School of Life Sciences, Huaiyin Normal University, Huai'an, China
| | - Peng Xiao
- Department of Dermatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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22
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Blei F. Update December 2021. Lymphat Res Biol 2021; 19:585-624. [PMID: 34958250 DOI: 10.1089/lrb.2021.29113.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Perri A, Tana M, Sbordone A, Patti ML, Sattin G, Vento G. "Open Questions" and Role of Lung Ultrasound in the Management of Congenital Chylothorax. Respiration 2021; 101:16-17. [PMID: 34814155 DOI: 10.1159/000520313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alessandro Perri
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Milena Tana
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annamaria Sbordone
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Letizia Patti
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Sattin
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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