[Neonatal chylothorax: aetiology, clinical course and efficacy of treatment].

OBJECTIVES

To investigate the aetiology, clinical course and response to treatment of neonatal chylothorax.

PATIENTS AND METHOD: Prospective study over a 2-year period in a neonatal intensive care unit of a tertiary university hospital. All newborns followed a predefined therapeutic protocol that included the sequential administration of total parenteral nutrition (TPN), octreotide and surgery. The influence of aetiology on outcome and response to treatment was investigated.

RESULTS

The study included 22 newborns. Surgery for congenital heart disease (CHD) (n = 14) and congenital diaphragmatic hernia (n = 4) were the most common aetiologies. The incidence of chylothorax in these aetiological groups was 11.2 % (95 % CI 5.7-16.8 %) and 26.6 % (95 % CI 4.3-40 %), respectively. Medical treatment was successful in 17 patients. Five of the 10 patients who did not respond to TPN were successfully treated with octreotide; none of the patients in whom octreotide failed responded to the subsequent 3 weeks of TPN. No side-effects were observed during octreotide administration. No significant association between aetiology and response to treatment was found, although all 4 patients who ultimately required surgery were in the CHD group. All patients had complications attributable to chylothorax. Five patients died during the 6 months of follow-up although mortality was never directly attributed to chylothorax.

CONCLUSIONS

Most patients can be successfully managed with medical treatment but early surgery should be considered in patients who do not respond to medical treatment. Aetiology is the main determinant of mortality. Randomized controlled studies are needed to demonstrate the efficacy and adequate timing of application of each therapeutic intervention.