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Erschienen in: Pediatric Cardiology 6/2016

18.04.2016 | Original Article

Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants

verfasst von: Kristi L. Fogg, Diane M. DellaValle, Jason R. Buckley, Eric M. Graham, Sinai C. Zyblewski

Erschienen in: Pediatric Cardiology | Ausgabe 6/2016

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Abstract

Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of −1 (−2 to 0.5) and −1.5 (−2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.
Literatur
1.
Zurück zum Zitat Biewer ES, Zurn C, Arnold R, Glockler M, Schulte-Monting J, Schlensak C, Dittrich S (2010) Chylothorax after surgery on congenital heart disease in newborns and infants-risk factors and efficacy of MCT-diet. J Cardiothorac Surg 5:127CrossRefPubMedPubMedCentral Biewer ES, Zurn C, Arnold R, Glockler M, Schulte-Monting J, Schlensak C, Dittrich S (2010) Chylothorax after surgery on congenital heart disease in newborns and infants-risk factors and efficacy of MCT-diet. J Cardiothorac Surg 5:127CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80:1864–1870CrossRefPubMed Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80:1864–1870CrossRefPubMed
3.
Zurück zum Zitat Mery CM, Moffett BS, Khan MS, Zhang W, Guzman-Pruneda FA, Fraser CD Jr, Cabrera AG (2014) Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 147:678–686CrossRefPubMed Mery CM, Moffett BS, Khan MS, Zhang W, Guzman-Pruneda FA, Fraser CD Jr, Cabrera AG (2014) Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 147:678–686CrossRefPubMed
4.
Zurück zum Zitat Zuluaga MT (2012) Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr 24:291–294CrossRefPubMed Zuluaga MT (2012) Chylothorax after surgery for congenital heart disease. Curr Opin Pediatr 24:291–294CrossRefPubMed
5.
Zurück zum Zitat Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ (2003) Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 31:28–33CrossRefPubMed Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ (2003) Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 31:28–33CrossRefPubMed
6.
Zurück zum Zitat Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C (2000) Etiology and management of pediatric chylothorax. J Pediatr 136:653–658CrossRefPubMed Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C (2000) Etiology and management of pediatric chylothorax. J Pediatr 136:653–658CrossRefPubMed
7.
Zurück zum Zitat Allen EM, van Heeckeren DW, Spector ML, Blumer JL (1991) Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg 26:1169–1174CrossRefPubMed Allen EM, van Heeckeren DW, Spector ML, Blumer JL (1991) Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg 26:1169–1174CrossRefPubMed
8.
Zurück zum Zitat Caverly L, Rausch CM, da Cruz E, Kaufman J (2010) Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis 5:573–578CrossRefPubMed Caverly L, Rausch CM, da Cruz E, Kaufman J (2010) Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery. Congenit Heart Dis 5:573–578CrossRefPubMed
9.
Zurück zum Zitat Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139:584–590CrossRefPubMed Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139:584–590CrossRefPubMed
10.
Zurück zum Zitat Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ (2009) Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 88:246–251CrossRefPubMed Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ (2009) Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 88:246–251CrossRefPubMed
11.
Zurück zum Zitat Yeh J, Brown ER, Kellogg KA, Donohue JE, Yu S, Gaies MG, Fifer CG, Hirsch JC, Aiyagari R (2013) Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. Ann Thorac Surg 96:930–936CrossRefPubMed Yeh J, Brown ER, Kellogg KA, Donohue JE, Yu S, Gaies MG, Fifer CG, Hirsch JC, Aiyagari R (2013) Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. Ann Thorac Surg 96:930–936CrossRefPubMed
14.
Zurück zum Zitat Goldman AS (2007) The immune system in human milk and the developing infant. Breastfeed Med 2:195–204CrossRefPubMed Goldman AS (2007) The immune system in human milk and the developing infant. Breastfeed Med 2:195–204CrossRefPubMed
15.
Zurück zum Zitat Raiten DJ, Kalhan SC, Hay WW Jr (2007) Maternal nutrition and optimal infant feeding practices: executive summary. Am J Clin Nutr 85:577S–583SPubMed Raiten DJ, Kalhan SC, Hay WW Jr (2007) Maternal nutrition and optimal infant feeding practices: executive summary. Am J Clin Nutr 85:577S–583SPubMed
16.
Zurück zum Zitat Taylor SN, Basile LA, Ebeling M, Wagner CL (2009) Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula. Breastfeed Med 4:11–15CrossRefPubMedPubMedCentral Taylor SN, Basile LA, Ebeling M, Wagner CL (2009) Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula. Breastfeed Med 4:11–15CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Walker WA (2004) The dynamic effects of breastfeeding on intestinal development and host defense. Adv Exp Med Biol 554:155–170CrossRefPubMed Walker WA (2004) The dynamic effects of breastfeeding on intestinal development and host defense. Adv Exp Med Biol 554:155–170CrossRefPubMed
18.
Zurück zum Zitat Geneva: World health organization (2009) WHO child growth standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations children’s fund Geneva: World health organization (2009) WHO child growth standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations children’s fund
19.
Zurück zum Zitat Wang CD, Chu PS, Mellen BG, Shenai JP (1999) Creamatocrit and the nutrient composition of human milk. J Perinatol 19:343–346CrossRefPubMed Wang CD, Chu PS, Mellen BG, Shenai JP (1999) Creamatocrit and the nutrient composition of human milk. J Perinatol 19:343–346CrossRefPubMed
20.
Zurück zum Zitat Kocel SL, Russell J, O’Connor DL (2015) Fat-modified breast milk resolves chylous pleural effusion in infants with postsurgical chylothorax but is associated with slow growth. JPEN J Parenter Enteral Nutr. doi:10.1177/0148607114566464 PubMed Kocel SL, Russell J, O’Connor DL (2015) Fat-modified breast milk resolves chylous pleural effusion in infants with postsurgical chylothorax but is associated with slow growth. JPEN J Parenter Enteral Nutr. doi:10.​1177/​0148607114566464​ PubMed
21.
Zurück zum Zitat del Castillo SL, McCulley ME, Khemani RG, Jeffries HE, Thomas DW, Peregrine J, Wells WJ, Starnes VA, Moromisato DY (2010) Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 11:373–377PubMed del Castillo SL, McCulley ME, Khemani RG, Jeffries HE, Thomas DW, Peregrine J, Wells WJ, Starnes VA, Moromisato DY (2010) Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 11:373–377PubMed
22.
Zurück zum Zitat Anderson JB, Marino BS, Irving SY, Garcia-Espana JF, Ravishankar C, Stallings VA, Medoff-Cooper B (2011) Poor post-operative growth in infants with two-ventricle physiology. Cardiol Young 21:421–429CrossRefPubMed Anderson JB, Marino BS, Irving SY, Garcia-Espana JF, Ravishankar C, Stallings VA, Medoff-Cooper B (2011) Poor post-operative growth in infants with two-ventricle physiology. Cardiol Young 21:421–429CrossRefPubMed
23.
Zurück zum Zitat Burch PT, Gerstenberger E, Ravishankar C et al (2014) Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial. J Am Heart Assoc 3:e000079CrossRefPubMedPubMedCentral Burch PT, Gerstenberger E, Ravishankar C et al (2014) Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial. J Am Heart Assoc 3:e000079CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Ravishankar C, Zak V, Williams IA et al (2013) Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: a report from the pediatric heart network infant single ventricle trial. J Pediatr 162:250–256CrossRefPubMed Ravishankar C, Zak V, Williams IA et al (2013) Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: a report from the pediatric heart network infant single ventricle trial. J Pediatr 162:250–256CrossRefPubMed
Metadaten
Titel
Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants
verfasst von
Kristi L. Fogg
Diane M. DellaValle
Jason R. Buckley
Eric M. Graham
Sinai C. Zyblewski
Publikationsdatum
18.04.2016
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 6/2016
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-016-1393-8

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