Use of Monogen for pediatric postoperative chylothorax

Postoperative chylothorax is a potentially serious complication of pediatric cardiac surgery. The purpose of this study was to report the use of Monogen enteral formula for the management of pediatric postoperative chylothorax.

A retrospective, single-institution 2-year study of all patients with a diagnosis of postoperative chylothorax was conducted. Chylothorax was diagnosed in 25 patients after a total of 535 cardiac operations in children younger than 10 years, for an incidence of 4.7%. Eighteen patients had been given Monogen, an enteral low long-chain triglyceride formula, as initial treatment. Six had been given total parenteral nutrition. The following variables were related to outcome and response to Monogen: age, sex, weight, underlying condition, type of surgery, interval between surgery and chylothorax diagnosis, duration and daily volume of chyle leak, central venous pressure, residual lesions, and weight loss.

Enteral feeding with Monogen was successful for 14 of 18 patients with a response to treatment evident by the end of the third day. No variables predicted which patients would respond to Monogen. Body weight was maintained or increased in 14 of the 17 surviving patients taking Monogen. A return to normal diet at 4 +/- 1 weeks from the day of pleural drain removal did not result in recurrent chylothorax.

A trial of Monogen is recommended as initial treatment for postoperative chylothorax unless enteral feeding is contraindicated.