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Nutritional, Metabolic, and Inflammatory Alterations in Children with Chylous Effusion in the Postoperative Period of
Sidney V Silva1, Tais D R Hortencio2, Lidiane O S Teles3
1Department of Pediatrics, State University of Campinas (UNICAMP), Campinas 13083-970, Brazil.
Insights
Chylous effusion after pediatric cardiac surgery is rising. Early diagnosis is crucial, as patients often show malnutrition, lymphopenia, hypoalbuminemia, and mineral imbalances like hypocalcemia.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Nutritional Science
Background:
- Chylous effusion incidence is increasing in children post-cardiac surgery due to surgical advancements.
- Understanding the clinical profile at diagnosis is essential for timely intervention.
Purpose of the Study:
- To describe the clinical characteristics of pediatric patients diagnosed with chylous effusion following cardiac surgery.
Main Methods:
- Retrospective cohort analysis of 23 patients (0-18 years) from January 2011 to July 2023.
- Data extracted from Multidisciplinary Nutritional Therapy Team (MNTT) records for nutritional support post-chylous effusion diagnosis.
Main Results:
- Predominantly younger patients (median age 6 months) with high malnutrition rates (60.9%).
- Common findings included lymphopenia (83%), hypoalbuminemia (74%), hypocalcemia (~50%), and hypophosphatemia (26%).
- Delayed effusion onset correlated with lower HDL cholesterol, lower albumin, greater surgical complexity, younger age, and lower weight.
Conclusions:
- Significant lymphopenia, hypoalbuminemia, low HDL cholesterol, and mineral imbalances (hypocalcemia, hypophosphatemia) are prevalent.
- These imbalances, if untreated, can lead to poor outcomes.
- Clinical and laboratory monitoring post-cardiac surgery is vital for early chylous effusion diagnosis and treatment initiation.
Objective:
The occurrence of chylous effusion in children undergoing cardiac surgery is progressively increasing due to technical advances that have led to a rise in the number of surgeries. In this context, the objective was to describe the clinical profile of a cohort of patients at the time of chylous effusion diagnosis.
Methods:
A retrospective cohort analysis was conducted between January 2011 and July 2023, involving 23 patients, aged 0 to 18 years, treated at a quaternary university hospital in southeastern Brazil. Data were obtained from the follow-up records of the Multidisciplinary Nutritional Therapy Team (MNTT) for patients who received nutritional support after developing chylous effusion in the postoperative period of cardiac surgery.
Results:
The younger population predominated (median age of 6 months), with a high prevalence of malnutrition (60.9%). At the time of chylous effusion diagnosis, 83% had lymphopenia, and 74% had hypoalbuminemia. The longer the time elapsed after surgery for the onset of chylous effusion, the lower the HDL cholesterol, the lower the albumin levels, the greater the surgical complexity, the younger the patient, and the lower their weight. Hypocalcemia occurred in nearly half of the sample and hypophosphatemia in 26% of the analyzed cases.
Conclusions:
There was a notable presence of lymphopenia, hypoalbuminemia, and low HDL cholesterol, as well as a high incidence of mineral imbalances, particularly hypocalcemia and hypophosphatemia, which, if untreated, may lead to unfavorable outcomes. Therefore, clinical and laboratory monitoring of children in the postoperative period of cardiac surgery is important and can aid in the early diagnosis of chylous effusion and, consequently, in the timely initiation of treatment.
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