Joseph T Church1, Alexis G Antunez2, Ashley Dean2, Niki Matusko2, Kristopher B Deatrick3, Mohammad A Attar4, Samir K Gadepalli2. 1. Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: jchurc@med.umich.edu. 2. Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. 3. Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA. 4. Section of Neonatology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
Abstract
PURPOSE: Management guidelines for infants with chylothorax lack substantial evidence. We sought to identify variables that impact outcomes in these patients in order to develop an evidence-based management algorithm. METHODS: We retrospectively reviewed the medical records of all infants diagnosed with chylothorax from June 2005 to December 2014 at our institution. Data collected included demographics, chest tube output (CTO), medical and dietary interventions, surgical procedures, and absolute lymphocyte count (ALC). Outcomes analyzed included death, sepsis, necrotizing enterocolitis (NEC), requiring surgery, and success of therapy, defined as CTO decrease by >50% within 7days. RESULTS: Of 178 neonates with chylothorax, initial therapy was high medium chain triglyceride (MCT) feedings in 106 patients, nothing by mouth (NPO), total parenteral nutrition (TPN) in 21, and NPO/TPN plus octreotide in 45. Octreotide use in addition to NPO/TPN revealed no significant differences in any outcome including success (47% vs. 43%, p=0.77). Initial CTO and ALC correlated with needing surgery (p=0.002 and p=0.006, respectively), and with death (p=0.028 and p=0.043, respectively). ALC also correlated with sepsis (p<0.001). CONCLUSIONS: Octreotide has no advantage over NPO/TPN alone in infants with chylothorax. CTO and ALC predict requiring surgery. We propose a management guideline based on CTO and ALC without a role for octreotide. TYPE OF STUDY: Retrospective case-control study. LEVEL OF EVIDENCE: 3.
PURPOSE: Management guidelines for infants with chylothorax lack substantial evidence. We sought to identify variables that impact outcomes in these patients in order to develop an evidence-based management algorithm. METHODS: We retrospectively reviewed the medical records of all infants diagnosed with chylothorax from June 2005 to December 2014 at our institution. Data collected included demographics, chest tube output (CTO), medical and dietary interventions, surgical procedures, and absolute lymphocyte count (ALC). Outcomes analyzed included death, sepsis, necrotizing enterocolitis (NEC), requiring surgery, and success of therapy, defined as CTO decrease by >50% within 7days. RESULTS: Of 178 neonates with chylothorax, initial therapy was high medium chain triglyceride (MCT) feedings in 106 patients, nothing by mouth (NPO), total parenteral nutrition (TPN) in 21, and NPO/TPN plus octreotide in 45. Octreotide use in addition to NPO/TPN revealed no significant differences in any outcome including success (47% vs. 43%, p=0.77). Initial CTO and ALC correlated with needing surgery (p=0.002 and p=0.006, respectively), and with death (p=0.028 and p=0.043, respectively). ALC also correlated with sepsis (p<0.001). CONCLUSIONS:Octreotide has no advantage over NPO/TPN alone in infants with chylothorax. CTO and ALC predict requiring surgery. We propose a management guideline based on CTO and ALC without a role for octreotide. TYPE OF STUDY: Retrospective case-control study. LEVEL OF EVIDENCE: 3.
Authors: M Dorsi; A Giuseppi; F Lesage; J Stirnemann; L De Saint Blanquat; M Nicloux; Z Assaf; N Khen Dunlop; E Kermorvant-Duchemin; J-F Magny; Y Ville; A Lapillonne Journal: J Perinatol Date: 2017-10-19 Impact factor: 2.521