Last update Dec. 10, 2024

Chylothorax

Compatible

Safe product and/or breastfeeding is the best option.

Chylothorax is the extravasation of chyle or lymph from the lymphatic system into the pleural space. In the first months of life it occurs after surgery for congenital malformations (heart disease, esophageal atresia, diaphragmatic hernia) or congenitally, associated or not with other malformations, often chromosomal, such as trisomy 2. (Samanidis 2022, Medoff 2010, Lumbreras 2009, Prada 2008, Yamamoto 1996)

Conservative treatments attempt to minimize or suppress lymphatic flow and obtain closure of the defect; they consist of total fasting and parenteral nutrition, diet free of long-chain fatty acids and rich in medium-chain triglycerides (MCT), octreotide (somatostatin analog) and respiratory support and pleural drainage when required (Martinez 2002, Kankanananarachchi 2021). Reparative surgery is a difficult option when the above has failed.

A significant percentage of patients improve with special formulas free of long-chain fatty acids and rich in MCT. (Biewer 2010, Lumbreras 2009)

Skimmed breast milk obtained after centrifugation and enriched or not with MCTs has been successfully tested (Clark 2023, Höck 2021, DiLauro 2020, Sanchez 2020, Neumann 2020, Concheiro 2019, Fogg 2016, Kocel 2016, Chan 2007, Hamdan 2004, Trish 2003). There are several effective and simple methods of removing fat from breast milk (Barbas 2020, Drewniak 2013). Obtaining skimmed breast milk by centrifuge in the family home has been shown to be feasible. (Huang 2024)

The existence of protective immune components in breast milk provides optimal nutrition far superior to commercial formula feeding and facilitates a return to breastfeeding administered directly from the breast. (Höck 2021)

The preparation of low-fat human milk decreases the IgA and protein content. In addition to fat (in the form of MCT), infants fed low-fat human milk are likely to require protein supplementation to support adequate growth. (Drewniak 2018)

Total fasting and parenteral nutrition may be required. Octreotide or somatostarin, which decrease intestinal absorption, are also another option. (Costa 2018, Lumbreras 2009, Prada 2008, Roehr 2005, Hamdan 2004, Rimensberger 1998)

The average number of days of introduction of normal diet is 9 days (range 3 to 59) which is worth knowing if breastfeeding is to be preserved by regular pumping and freezing.

Alternatives

We do not have alternatives for Chylothorax since it is relatively safe.

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

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Chylothorax in other languages or writings:

Group

Chylothorax belongs to this group or family:

References

  1. Huang Y, Nyangau EM, Vyas NB, Joseph D, Laviolette LS, Tucker KN, Enderle JL. The Practicality of Preparing Skim Breast Milk at Home for Treatment of Infants Requiring Low Fat Diets. Breastfeed Med. 2024 Mar;19(3):217-222. Abstract
  2. Clark B, Froh M, Karls C, Feuling MB, Goday P, Uhing M, Handler SS, Nghiem-Rao TH, Polzin E. Assessing growth of infants with chylothorax receiving fortified skimmed human breast milk. Nutr Clin Pract. 2023 Feb;38(1):199-203. Abstract Full text (link to original source)
  3. 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 Apr 26;14(9). Abstract Full text (link to original source)
  4. Kankananarachchi I, Priyankara KKS, Lakman KKK, Withanaarachchi K, Gunathilaka PKG. Two Cases of Congenital Chylethorax: A Successful Story of Medical Management. Case Rep Pediatr. 2021 Aug 7;2021:6634326. Abstract Full text (link to original source)
  5. Höck M, Höller A, Hammerl M, Wechselberger K, Krösslhuber J, Kiechl-Kohlendorfer U, Scholl-Bürgi S, Karall D. Dietary treatment of congenital chylothorax with skimmed breast milk. Ital J Pediatr. 2021 Aug 26;47(1):175. Abstract Full text (link to original source)
  6. Barbas KH, O'Brien K, Forbes PW, Belfort MB, Connor JA, Thiagarajan RR, Huh SY. Macronutrient Analysis of Modified-Fat Breast Milk Produced by 3 Methods of Fat Removal. JPEN J Parenter Enteral Nutr. 2020 Jul;44(5):895-902. Abstract
  7. DiLauro S, Russell J, McCrindle BW, Tomlinson C, Unger S, O'Connor DL. Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient-enrichment and advancement feeding protocols; an open-label trial. Clin Nutr ESPEN. 2020 Aug;38:19-27. Abstract Full text (link to original source)
  8. Sánchez Luna M, Caballero Martín S, Sánchez Gomez de Orgaz MDC, Rodriguez Corrales E, Jové Blanco A. Leche materna descremada en recién nacidos con quilotórax: opciones con una unidad de nutrición personalizada. [Skimmed breast milk in newborns with chylothorax: Options with a personalised nutrition unit]. An Pediatr (Engl Ed). 2020 Sep;93(3):194-195. Abstract Full text (link to original source)
  9. Neumann L, Springer T, Nieschke K, Kostelka M, Dähnert I. ChyloBEST: Chylothorax in Infants and Nutrition with Low-Fat Breast Milk. Pediatr Cardiol. 2020 Jan;41(1):108-113. Abstract
  10. Concheiro-Guisan A, Alonso-Clemente S, Suarez-Albo M, Duran-Fernandez Feijoo C, Fiel-Ozores A, Fernandez-Lorenzo JR. The Practicality of Feeding Defatted Human Milk in the Treatment of Congenital Chylothorax. Breastfeed Med. 2019 Nov;14(9):648-653. Abstract
  11. Drewniak M, Waterhouse CCM, Lyon AW, Fenton TR. Immunoglobulin A and Protein Content of Low-Fat Human Milk Prepared for the Treatment of Chylothorax. Nutr Clin Pract. 2018 Oct;33(5):667-670. Abstract
  12. Costa KM, Saxena AK. Surgical chylothorax in neonates: management and outcomes. World J Pediatr. 2018 Apr;14(2):110-115. Abstract
  13. Fogg KL, DellaValle DM, Buckley JR, Graham EM, Zyblewski SC. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants. Pediatr Cardiol. 2016 Aug;37(6):1072-7. Abstract
  14. Kocel SL, Russell J, O'Connor DL. Fat-Modified Breast Milk Resolves Chylous Pleural Effusion in Infants With Postsurgical Chylothorax but Is Associated With Slow Growth. JPEN J Parenter Enteral Nutr. 2016 May;40(4):543-51. Abstract
  15. Drewniak MA, Lyon AW, Fenton TR. Evaluation of fat separation and removal methods to prepare low-fat breast milk for fat-intolerant neonates with chylothorax. Nutr Clin Pract. 2013 Oct;28(5):599-602. Abstract
  16. 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)
  17. Medoff-Cooper B, Naim M, Torowicz D, Mott A. Feeding, growth, and nutrition in children with congenitally malformed hearts. Cardiol Young. 2010 Abstract
  18. 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)
  19. 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)
  20. 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)
  21. 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)
  22. 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)
  23. 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)
  24. 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)
  25. 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)
  26. 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)
  27. 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

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