Chylothorax

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.