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Management of nutritional and infectious complications of postoperative chylothorax in children
E M Allen1, D W van Heeckeren, M L Spector
1Division of Pediatric Pharmacology, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
Insights
Postoperative chylothorax in children can be managed with chest tube drainage and nutritional support. Both medium-chain triglyceride-enriched enteral formulas and total parenteral nutrition effectively supported patients, with no correlation found between infections and lymphocyte levels.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Postoperative chylothorax is a recognized complication following intrathoracic procedures in pediatric patients.
- Early diagnosis and management are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of initial therapeutic strategies for pediatric postoperative chylothorax.
- To assess nutritional support methods and the incidence of complications, including lymphopenia and infections.
Main Methods:
- Retrospective review of 18 pediatric patients diagnosed with chylothorax between 1979 and 1987.
- Analysis of initial management including chest tube placement and nutritional support (enteral with medium-chain triglycerides or total parenteral nutrition).
- Evaluation of lymphopenia and infectious complications.
Main Results:
- Chest tube drainage and nutritional support were the primary treatments.
- Both medium-chain triglyceride-enriched enteral formulas and total parenteral nutrition provided adequate nutritional support.
- Five patients developed lymphopenia due to chylous lymphocyte loss; five patients experienced infections, including one fatal case of viral pneumonitis.
Conclusions:
- Initial management with chest tube drainage and appropriate nutritional support is effective for pediatric postoperative chylothorax.
- While lymphopenia can occur, it did not correlate with infectious complications in this cohort.
- Further research may explore long-term outcomes and specific risk factors.
Abstract:
Postoperative chylothorax may occur following any intrathoracic surgical procedure in children. From January 1979 through February 1987, 18 children aged 1 month to 9 years had chylothorax listed among their discharge diagnoses. Initial therapy for all patients consisted of chest tube placement for pleural space drainage and nutritional support with either enteral formulas enriched with medium-chain triglycerides or total parenteral nutrition. Both total parenteral nutrition and medium-chain triglyceride-enriched enteral regimens provided adequate nutritional support in these children. Five of the 18 experienced lymphopenia secondary to chylous lymphocyte loss. Infections were diagnosed in 5 patients during hospitalization; one was a fatal viral pneumonitis. No correlation between infectious complications and lymphocyte count could be demonstrated.