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Published on: March 12, 2019
Somatostatin for intractable postoperative chylothorax in a premature infant
S A Clarke1, K Lakhoo, W Sherwood
1Department of Paediatric Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. SClarke3005@aol.com
Insights
This study reports the successful use of somatostatin in a premature infant to treat postoperative chylothorax, a rare lymphatic complication. The treatment significantly reduced chyle drainage, offering a new therapeutic option for neonates.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Surgical complications
Background:
- Premature infants often require complex surgical interventions.
- Oesophageal atresia and tracheo-oesophageal fistula are congenital anomalies requiring surgical repair.
- Postoperative chylothorax is a rare but serious complication following thoracic surgery in neonates.
Observation:
- A 31-week premature infant developed a lymphatic leak during repair of oesophageal atresia, tracheo-oesophageal fistula, and anal stenosis.
- Persistent chylous drainage (chylothorax) was observed post-surgery.
- Intravenous somatostatin infusion was initiated to manage the chylous leak.
Findings:
- Somatostatin treatment led to a dramatic reduction in chyle drainage within 24 hours.
- Chyle drainage became negligible by the fifth day of somatostatin therapy.
- No recurrence of chylothorax was observed after discontinuing somatostatin.
Implications:
- This case highlights somatostatin as a potentially effective treatment for postoperative chylothorax in extremely premature infants.
- It represents the youngest reported successful use of somatostatin for this condition.
- Further research may explore somatostatin's role in managing neonatal chylothorax and other lymphatic leaks.
Abstract:
A premature infant of 31 weeks' gestation underwent repair of an oesophageal atresia, distal tracheo-oesophageal fistula and anal stenosis. A lymphatic leak was noted at the time of surgery. Chylous drainage persisted and an intravenous infusion of somatostatin was begun. The volume of chyle drained fell dramatically within the first 24 h and was negligible by the 5th day of treatment. No reaccumulation of the chylothorax was seen after the cessation of somatostatin. To our knowledge this is the youngest reported child in whom somatostatin has been used successfully in treating a postoperative chylothorax.
