Massive chylothorax in small babies. J Pediatr Surg 2009 Mar;44(3):546-50
Date
03/24/2009Pubmed ID
19302856DOI
10.1016/j.jpedsurg.2008.08.008Scopus ID
2-s2.0-62149091853 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
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 RKAuthor
Ronald K. Woods MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ChylothoraxDrainage
Fibrin Tissue Adhesive
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Ligation
Pleurodesis
Retrospective Studies
Thoracic Duct
Tissue Adhesives
Treatment Outcome