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Octreotide for chylous effusions in congenital diaphragmatic hernia
Melissa W Landis1, Dawn Butler, Foong Yen Lim
1The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
Octreotide did not significantly reduce chylous effusions in infants with congenital diaphragmatic hernia (CDH). Conservative management alone appears sufficient for most CDH-related chylothorax cases.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Thoracic Surgery
Background:
- Chylothorax is a common and serious complication in infants with congenital diaphragmatic hernia (CDH).
- Current optimal treatment strategies for CDH-related chylothorax are not well-defined.
- Octreotide is being investigated as a potential treatment to reduce chylous effusions.
Purpose of the Study:
- To evaluate the efficacy of octreotide in decreasing chylous effusions in infants diagnosed with congenital diaphragmatic hernia (CDH).
- To compare conservative management with octreotide therapy for chylothorax in CDH infants.
Main Methods:
- Retrospective analysis of infants with CDH admitted between October 2006 and October 2011.
- Comparison of outcomes between infants managed conservatively (thoracostomy, total parenteral nutrition) and those treated with octreotide.
- Assessment of chest tube output, length of stay, and survival to discharge.
Main Results:
- 12% of CDH infants (11/91) developed chylothorax.
- No significant differences in survival, length of stay, or daily chest tube output were observed between conservative and octreotide groups.
- A temporary decrease in chest tube output was noted with octreotide initiation in some cases, but the overall drainage rate remained unchanged.
Conclusions:
- Conservative management, including thoracostomy and total parenteral nutrition, is effective for the majority of chylous effusions in CDH infants.
- Octreotide therapy did not demonstrate a significant benefit over conservative management for CDH-related chylothorax.
- Further research may be needed to identify specific subgroups of CDH patients who might benefit from octreotide.
Background/Purpose:
Chylothorax is a frequent complication in congenital diaphragmatic hernia (CDH) infants and is associated with significant morbidity. The optimal treatment strategy remains unclear. We hypothesize that octreotide decreases chylous effusions in infants with CDH.
Methods:
This is a retrospective study of all infants with CDH admitted to our institution from October 2006 to October 2011.
Results:
Eleven (12%) infants developed a chylothorax. Five infants were managed conservatively with thoracostomy and total parenteral nutrition. Six infants were started on octreotide therapy. None of the infants required surgical intervention to stop the effusion. There was no significant difference in survival to discharge, length of stay, or average daily chest tube output between groups. There appeared to be a temporally associated drop in chest tube output upon initiation of octreotide in two infants; however, the overall rate of decline in chest tube drainage was unchanged. In addition, there were infants in the conservative group who demonstrated a similar drop in daily chest tube output despite the absence of octreotide.
Conclusions:
Our data suggest that the majority of chylous effusions in CDH infants resolve with conservative therapy alone.
