Last update Jan. 25, 2014

Chylothorax

Low Risk

Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Chylothorax is the result of pleural effusion caused by accumulation of chyle or lymphatic fluid in the pleural cavity. In the first months of life it occurs after correction surgery of congenital heart anomalies like heart defects, esophageal atresia or diaphragmatic hernia. Some are congenital in origin associated or not with other defects (mostly chromosomic derangements).

Conservative treatments are intended to minimize or avoid lymphatic flux in order to attain the defect closure.

Seventy percent of patients ameliorate by the use of especial long-chain free and middle-chain triglyceride (MCT) enriched formulas. Fat-free human milk obtained by centrifugation, enriched or not with middle chain triglycerides, has been successfully used as a treatment.

Fully fasting and total parenteral nutrition is sometimes needed. Octreotide (octapeptide somatostatin analogue) may be another option.

The mean for normal feeding initiation is 9 days (3 to 59 days), thus it is important to know if milk production is desirable to maintain by means of frequent pump extraction and freezing.

The best result among different conservative treatments is not clearly defined.

Corrective surgery is a difficult decision when conservative treatments have failed.

Alternatives

We do not have alternatives for Chylothorax.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Group

Chylothorax belongs to this group or family:

References

  1. Medoff-Cooper B, Naim M, Torowicz D, Mott A. Feeding, growth, and nutrition in children with congenitally malformed hearts. Cardiol Young. 2010 Abstract
  2. Biewer ES, Zürn C, Arnold R, Glöckler M, Schulte-Mönting J, Schlensak C, Dittrich S. Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet. J Cardiothorac Surg. 2010 Abstract Full text (in our servers)
  3. Lumbreras Fernández J, Sánchez Díaz JI. Quilotórax: experiencia en una unidad de cuidados intensivos pediátricos. \ [Chylothorax: experience in a paediatric intensive care unit]. An Pediatr (Barc). 2009 Abstract Full text (in our servers)
  4. Prada Arias M, Rodríguez Barca P, Carbajosa Herrero MT, de Celis Villasana L, Viñals González F. Quilotórax tras reparación de atresia de esófago: tratamiento conservador con ctreotida. \ [Chylothorax following repair of oesophageal atresia: conservative treatment with octreotide]. An Pediatr (Barc). 2008 Abstract Full text (in our servers)
  5. Chan GM, Lechtenberg E. The use of fat-free human milk in infants with chylous pleural effusion. J Perinatol. 2007 Abstract Full text (in our servers)
  6. Roehr CC, Jung A, Curcin OA, Proquitte H, Hammer H, Wauer RR. Loculated neonatal chylothorax treated with octreotide: complete recovery while on unrestricted full fat breast milk. Ann Thorac Surg. 2005 Abstract Full text (in our servers)
  7. Hamdan MA, Gaeta ML. Octreotide and low-fat breast milk in postoperative chylothorax. Ann Thorac Surg. 2004 Abstract Full text (link to original source) Full text (in our servers)
  8. Trish Whitehouse \ \ La leche de Bobby: Amamantar a un bebé con Quilotórax LEAVEN, volumen 39, número 2, abril-mayo 2003 2003 Full text (in our servers)
  9. Trish Whitehouse \ \ Bobby’s Dairy: Nursing a Baby with Chylothorax LEAVEN, Vol. 39 No. 2, April-May 2003, pp. 27-30. 2003 Full text (in our servers)
  10. Martínez Tallo E, Hernández Rastrollo R, Agulla Rodiño E, Sanjuán Rodríguez S, Campello Escudero E. [Neonatal chylothorax and conservative treatment]. An Esp Pediatr. 2002 Abstract Full text (in our servers)
  11. Al-Tawil K, Ahmed G, Al-Hathal M, Al-Jarallah Y, Campbell N. Congenital chylothorax. Am J Perinatol. 2000 Abstract
  12. Kelly RF, Shumway SJ. Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg. 2000 Abstract Full text (in our servers)
  13. Rimensberger PC, Müller-Schenker B, Kalangos A, Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg. 1998 Abstract Full text (in our servers)
  14. Yamamoto T, Koeda T, Tamura A, Sawada H, Nagata I, Nagata N, Ito T, Mio Y. Congenital chylothorax in a patient with 21 trisomy syndrome. Acta Paediatr Jpn. 1996 Abstract
  15. Jernite M, Donato L, Favre R, Haddad J, Esposito M, Messer J. [Medical treatment of chylous effusions in newborn infants. Apropos of 3 cases]. Arch Fr Pediatr. 1992 Abstract

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