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Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Jie Zheng1, Ying-Yi Chen2, Chun-Ying Zhang3

  • 1Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan, China. 869272574@qq.com.

The Heart Surgery Forum
|January 5, 2021
PubMed

Insights

Enteral nutrition with medium-chain triglycerides (MCT) is more effective and cost-efficient for treating pediatric chylothorax post-cardiac surgery than total parenteral nutrition (TPN). This approach leads to faster recovery and shorter hospital stays.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Nutritional Management

Background:

  • Chylothorax results from thoracic lymphatic injury, often complicating cardiac surgery.
  • Limited and inconsistent data exist comparing enteral nutrition with medium-chain triglycerides (EN with MCT) and total parenteral nutrition (TPN) for pediatric chylothorax.
  • This study evaluates chylothorax incidence and optimal nutritional strategies in pediatric patients.

Purpose of the Study:

  • To determine the incidence of chylothorax in children undergoing cardiac surgery at our institution.
  • To compare the therapeutic and cost-effectiveness of EN with MCT versus TPN for managing pediatric chylothorax.
  • To identify optimal nutritional management for pediatric chylothorax.

Main Methods:

  • Retrospective review of medical records for pediatric patients diagnosed with chylothorax between 2014 and 2018.
  • Analysis of chylothorax incidence, therapeutic outcomes, and cost-effectiveness of EN with MCT and TPN.
  • Comparison of clinical outcomes including time to resolution, drainage tube removal, and hospital stay.

Main Results:

  • Chylothorax occurred in 5.62% of congenital heart disease surgeries, with 136 identified cases.
  • Patients receiving EN with MCT (n=28) showed significantly lower nutrition support costs compared to TPN (n=17) (P=.000).
  • EN with MCT resulted in shorter time to resolution (P=.003) and hospital stay (P=.032) than TPN.

Conclusions:

  • EN with MCT demonstrates superior therapeutic effects and cost-effectiveness compared to TPN for pediatric chylothorax.
  • EN with MCT is recommended as a first-line treatment for chylothorax with mild chest drainage when gastrointestinal function is viable.
  • This approach offers faster recovery and reduced healthcare costs in pediatric cardiac surgery patients.
Abstract

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