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Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis
P Mussat1, M Dommergues, S Parat
1Service de Médecine Néonatale de Port-Royal, Centre Hospitalier Universitaire Cochin Port-Royal, Paris, France.
Insights
Antenatal pleuroamniotic shunting may improve outcomes for fetal chylothorax with hydrops. Persistent fetal chylothorax at birth can resolve with medical management, leading to recovery.
Area of Science:
- Perinatology
- Fetal Medicine
- Neonatal Surgery
Background:
- Fetal chylothorax with hydrops is a serious condition with significant mortality.
- Antenatal interventions are explored to improve fetal outcomes.
Purpose of the Study:
- To evaluate the effectiveness of antenatal pleuroamniotic shunting in managing fetal chylothorax with hydrops.
- To assess the outcomes of liveborn infants with congenital chylothorax.
Main Methods:
- Retrospective analysis of 25 cases of fetal chylothorax with hydrops.
- Inclusion of data on antenatal pleuroamniotic shunting (20/25 cases).
- Tracking of neonatal outcomes, including mortality, respiratory support, and duration of treatment.
Main Results:
- Four infants with resolved chylothorax post-shunting were born at term with no respiratory issues.
- Seven premature infants with persistent chylothorax required intensive respiratory care, including mechanical ventilation (median 34 days).
- Survivors received total parenteral nutrition (median 31 days) and were discharged after recovery (median age 64 days).
Conclusions:
- Antenatal pleuroamniotic shunting appears to improve the prognosis for fetal chylothorax complicated by hydrops.
- Congenital chylothorax persisting at birth can be managed medically, with progressive resolution and eventual recovery.
Abstract:
We consecutively managed 25 cases of fetal chylothorax with hydrops (pleuroamniotic shunting in 20/25 cases). Three of the 16 liveborn infants died before day 5 from malformations (n = 1) or complications of antenatal origin (n = 2). Eleven of the 13 survivors were treated in our unit. Four infants whose chylothorax had resolved before birth following antenatal shunting were delivered at term, and had no respiratory disease. Seven infants, whose chylothorax persisted, were delivered prematurely and required intensive respiratory care (with mechanical ventilation for a median duration of 34 days). The 11 infants were maintained on total parenteral nutrition for a median duration of 31 days. They were discharged home after complete clinical recovery at a median age of 64 days. Antenatal pleuroamniotic shunting may improve the prognosis of congenital chylothorax with hydrops. Chylothorax persisting at birth resolves progressively with medical management.