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Chylothorax in the neonate-A stepwise approach algorithm.

Gustavo Rocha1, Vanessa Arnet1, Paulo Soares1,2

  • 1Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.

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|July 29, 2021
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Summary
This summary is machine-generated.

Neonatal chylothorax, a lymphatic duct leakage, lacks treatment consensus. This review presents current therapeutic options and proposes a stepwise algorithm for managing congenital and traumatic cases in newborns.

Keywords:
approachchylothoraxlymphoctreotidepleural effusionsurgery

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Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Thoracic Surgery

Background:

  • Neonatal chylothorax involves lymphatic fluid leakage from thoracic ducts, presenting as congenital or posttraumatic conditions.
  • The clinical presentation and management of neonatal chylothorax are highly variable, with no established treatment guidelines.
  • This review addresses the heterogeneity in neonatal chylothorax management.

Purpose of the Study:

  • To review current therapeutic strategies for neonatal chylothorax.
  • To present evidence and recommendations for treatment modalities.
  • To establish a consensus on the timing and approach to treatment.

Main Methods:

  • Comprehensive literature search of PubMed, Cochrane Database, and UpToDate (1970-2020).
  • Systematic review of publications on neonatal chylothorax treatment.
  • Development of a stepwise algorithm for guiding clinical management.

Main Results:

  • Treatment typically involves supportive care, pleural drainage, and measures to decrease chyle production.
  • A stepwise approach, starting with conservative interventions, is recommended.
  • Treatment invasiveness is escalated based on patient response.

Conclusions:

  • A practical, stepwise algorithm is proposed for managing both congenital and traumatic neonatal chylothorax.
  • This approach aims to guide clinicians in a rational and systematic manner.
  • The review provides a framework for evidence-based treatment decisions.