Faculty Collaboration Database

Massive chylothorax in small babies. J Pediatr Surg 2009 Mar;44(3):546-50

Date

03/24/2009

Pubmed ID

19302856

DOI

10.1016/j.jpedsurg.2008.08.008

Scopus ID

2-s2.0-62149091853 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

PURPOSE: Perceptions on the role and timing of surgical intervention for high-output or massive chylothorax in small and premature babies remain varied. We reviewed our experience with this challenging group of patients to help refine our thinking and devise a more consistent strategy for management.

METHODS: We conducted a retrospective analysis of all patients in our institutions' neonatal populations diagnosed with chylothorax from June 2000 to April 2008.

RESULTS: Of a total of 23 patients (birth weight, 0.54-4.5 kg; gestational age, 23-41 weeks), 17 were treated conservatively, and 6 with massive chylothorax (>50 mL/kg per day) were treated surgically. Surgical treatment varied, including en masse thoracic duct ligation, mechanical pleurodesis, and application of fibrin glue. Survival in the surgically treated group was 83% vs 59% in the conservatively treated group. Median duration of chest tube drainage was 5 days (postoperative, range, 4-16) in the surgically treated group vs 14 days (range, 1-68) in the conservatively treated group.

CONCLUSION: Surgery has a definitive role in the care of small babies with massive chylothorax. Daily output exceeding 50 mL/kg per day with no or minimal response to 3 days of maximal medical therapy may indicate a potential therapeutic benefit of surgery.

Author List

Cleveland K, Zook D, Harvey K, Woods RK

MESH terms used to index this publication - Major topics in bold

Chylothorax
Drainage
Fibrin Tissue Adhesive
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Ligation
Pleurodesis
Retrospective Studies
Thoracic Duct
Tissue Adhesives
Treatment Outcome