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Congenital chylothorax
K Al-Tawil1, G Ahmed, M Al-Hathal
1Department of Pediatrics, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Insights
Congenital chylothorax in infants has a 100% survival rate with current treatments. Early use of breast milk or standard formula is recommended before considering medium-chain triglyceride (MCT) rich formulas.
Area of Science:
- Pediatrics
- Neonatology
- Thoracic Surgery
Background:
- Congenital chylothorax is a rare condition in newborns.
- It involves the accumulation of lymphatic fluid in the chest cavity.
- Management strategies and outcomes require further investigation.
Purpose of the Study:
- To conduct a retrospective study of infants treated for congenital chylothorax.
- To analyze management, outcomes, and complications in two international hospitals.
- To evaluate the prognosis of congenital chylothorax based on various factors.
Main Methods:
- Retrospective review of infant medical records from Royal Children's Hospital (1982-1994) and King Fahad National Guard Hospital (1992-1998).
- Inclusion criteria: all infants treated for congenital chylothorax.
- Data collected: management strategies, duration of ventilation and TPN, complications, and survival rates.
Main Results:
- Nineteen infants (13 female, 8 male) were studied.
- 100% survival rate was achieved regardless of treatment modality.
- Hydropic infants experienced longer ventilation and hospital stays compared to non-hydropic infants.
Conclusions:
- Congenital chylothorax, even in the presence of hydrops fetalis, has a good prognosis in term and preterm infants.
- Initial management should prioritize breast milk or standard infant formula.
- Surgical intervention is reserved for cases refractory to conservative management for 4-5 weeks.
Abstract:
The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.