Skip to main content
Erschienen in:

11.04.2023 | Original Article

Neonatal Lymphatic Flow Disorder

verfasst von: Handan Hakyemez Toptan, Elif Ozalkaya, Nilgun Karadag, Sevilay Topcuoglu, Emre Dincer, Guner Karatekin

Erschienen in: Indian Journal of Pediatrics | Ausgabe 3/2024

Einloggen, um Zugang zu erhalten

Abstract

Objective

To examine and discuss patients diagnosed with acquired and congenital chylothorax in the neonatal period in the light of the literature.

Methods

The files of newborns followed-up in the neonatal intensive care unit (NICU) and diagnosed with congenital and acquired chylothorax were reviewed retrospectively. Patients with isolated chylothorax were classified as Group 1 and those with multiple lymphatic flow disorders were classified as Group 2. Antenatal and clinical features were recorded and compared between the groups.

Results

Thirteen infants were diagnosed with chylothorax; 92.3% (n = 12) of the patients were congenital. The rate of antenatal diagnosis was 61.5% (n = 8). Eight patients (61.5%) were diagnosed with hydrops fetalis. Among the cases in Group 1 and Group 2, receiving ocreotide and the incidence of sepsis (p = 0.05) were partially significant. Seven of the patients (66.6%) responded to medium chain triglycerides (MCT), and complete resolution was seen in 6 (85.7%) of the responders. Complete resolution of chylothorax fluid was observed in 7 (77.7%) of nine patients who responded to ocreotide treatment.

Conclusions

In neonatal chylothorax, the postnatal period includes a multidisciplinary approach that requires drug therapy, dietary modifications, drainage of pleural fluid, and rarely, surgery.
Literatur
1.
3.
Zurück zum Zitat Bellini C, Ergaz Z, Boccardo F, et al. Dynamics of pleural fluid effusion and chylothorax in the fetus and newborn: role of the lymphatic system. Lymphology. 2013;46:75–84.PubMed Bellini C, Ergaz Z, Boccardo F, et al. Dynamics of pleural fluid effusion and chylothorax in the fetus and newborn: role of the lymphatic system. Lymphology. 2013;46:75–84.PubMed
4.
Zurück zum Zitat Krishnamurthy MB, Malhotra A. Congenital chylothorax: current perspectives and trends. Res Rep Neonatol. 2017;7:53–63. Krishnamurthy MB, Malhotra A. Congenital chylothorax: current perspectives and trends. Res Rep Neonatol. 2017;7:53–63.
5.
Zurück zum Zitat Büttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest. 1999;116:682–7.CrossRefPubMed Büttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest. 1999;116:682–7.CrossRefPubMed
6.
Zurück zum Zitat Bellini C, Cabano R, Bellini T, Boccardo F, Morcaldi G, Ramenghi LA. Congenital chylothorax of the newborn: diagnosis and treatment in three pictures. Lymphology. 2016;49:150–6.PubMed Bellini C, Cabano R, Bellini T, Boccardo F, Morcaldi G, Ramenghi LA. Congenital chylothorax of the newborn: diagnosis and treatment in three pictures. Lymphology. 2016;49:150–6.PubMed
7.
Zurück zum Zitat Bialkowski A, Poets CF, Franz AR; Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland Study Group. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed. 2015;100:F169–72.CrossRefPubMed Bialkowski A, Poets CF, Franz AR; Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland Study Group. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed. 2015;100:F169–72.CrossRefPubMed
8.
Zurück zum Zitat Dorsi M, Giuseppi A, Lesage F, et al. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol. 2018;38:31–4.CrossRefPubMed Dorsi M, Giuseppi A, Lesage F, et al. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol. 2018;38:31–4.CrossRefPubMed
9.
Zurück zum Zitat Levine C. Primary disorders of the lymphatic vessels – a unified concept. J Pediatr Surg. 1989;24:233–40.CrossRefPubMed Levine C. Primary disorders of the lymphatic vessels – a unified concept. J Pediatr Surg. 1989;24:233–40.CrossRefPubMed
10.
Zurück zum Zitat Costa KM, Saxena AK. Surgical chylothorax in neonates: management and outcomes. World J Pediatr. 2018;14:110–5.CrossRefPubMed Costa KM, Saxena AK. Surgical chylothorax in neonates: management and outcomes. World J Pediatr. 2018;14:110–5.CrossRefPubMed
11.
Zurück zum Zitat White MK, Bhat R, Greenough A. Neonatal chylothoraces: a 10-year experience in a Tertiary Neonatal Referral Centre. Case Rep Pediatr. 2019;2019:3903598. White MK, Bhat R, Greenough A. Neonatal chylothoraces: a 10-year experience in a Tertiary Neonatal Referral Centre. Case Rep Pediatr. 2019;2019:3903598.
12.
Zurück zum Zitat Mosby. Mosby’s medical, nursing and allied health dictionary. In: Anderson K, Aderson LE, Glanze WD, editors. 4th ed. Maryland Heights: Mosby; 1994. p. 335. Mosby. Mosby’s medical, nursing and allied health dictionary. In: Anderson K, Aderson LE, Glanze WD, editors. 4th ed. Maryland Heights: Mosby; 1994. p. 335.
13.
Zurück zum Zitat Le Nué R, Molinaro F, Gomes-Ferreira C, et al. Surgical management of congenital chylothorax in children. Eur J Pediatr Surg. 2010;20:307–11.CrossRefPubMed Le Nué R, Molinaro F, Gomes-Ferreira C, et al. Surgical management of congenital chylothorax in children. Eur J Pediatr Surg. 2010;20:307–11.CrossRefPubMed
14.
Zurück zum Zitat Bellini C, Cabano R, De Angelis LC, et al. Octreotide for congenital and acquired chylothorax in newborns: a systematic review. J Paediatr Child Health. 2018;54:840–7.CrossRefPubMed Bellini C, Cabano R, De Angelis LC, et al. Octreotide for congenital and acquired chylothorax in newborns: a systematic review. J Paediatr Child Health. 2018;54:840–7.CrossRefPubMed
15.
Zurück zum Zitat Malleske DT, Yoder BA. Congenital chylothorax treated with oral sildenafil: a case report and review of the literature. J Perinatol. 2015;35:384–6.CrossRefPubMed Malleske DT, Yoder BA. Congenital chylothorax treated with oral sildenafil: a case report and review of the literature. J Perinatol. 2015;35:384–6.CrossRefPubMed
16.
Zurück zum Zitat Mitchell K, Weiner A, Ramsay P, Sahni M. Use of propranolol in the treatment of chylous effusions in infants. Pediatrics. 2021;148:e2020049699.CrossRefPubMed Mitchell K, Weiner A, Ramsay P, Sahni M. Use of propranolol in the treatment of chylous effusions in infants. Pediatrics. 2021;148:e2020049699.CrossRefPubMed
17.
Zurück zum Zitat Kugelman A, Gonen R, Bader D. Potential role of high-frequency ventilation in the treatment of severe congenital pleural effusion. Pediatr Pulmonol. 2000;29:404–8.CrossRefPubMed Kugelman A, Gonen R, Bader D. Potential role of high-frequency ventilation in the treatment of severe congenital pleural effusion. Pediatr Pulmonol. 2000;29:404–8.CrossRefPubMed
18.
Zurück zum Zitat Scottoni F, Fusaro F, Conforti A, Morini F, Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: personal experience and literature review. J Pediatr Surg. 2015;50:1722–5.CrossRefPubMed Scottoni F, Fusaro F, Conforti A, Morini F, Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: personal experience and literature review. J Pediatr Surg. 2015;50:1722–5.CrossRefPubMed
19.
Zurück zum Zitat Bernet-Buettiker V, Waldvogel K, Cannizzaro V, Albisetti M. Antithrombin activity in children with chylothorax. Eur J Cardiothorac Surg. 2006;29:406–9.PubMed Bernet-Buettiker V, Waldvogel K, Cannizzaro V, Albisetti M. Antithrombin activity in children with chylothorax. Eur J Cardiothorac Surg. 2006;29:406–9.PubMed
20.
Zurück zum Zitat Hoskote AU, Ramaiah RN, Cale CM, Hartley JC, Brown KL. Role of immunoglobulin supplementation for secondary immunodeficiency associated with chylothorax after pediatric cardiothoracic surgery. Pediatr Crit Care Med. 2012;13:535–41.CrossRefPubMed Hoskote AU, Ramaiah RN, Cale CM, Hartley JC, Brown KL. Role of immunoglobulin supplementation for secondary immunodeficiency associated with chylothorax after pediatric cardiothoracic surgery. Pediatr Crit Care Med. 2012;13:535–41.CrossRefPubMed
21.
Zurück zum Zitat McMullan DM. Should intravenous immunoglobulin be given to patients with postoperative chylothorax? Pediatr Crit Care Med. 2012;13:599–600.CrossRefPubMed McMullan DM. Should intravenous immunoglobulin be given to patients with postoperative chylothorax? Pediatr Crit Care Med. 2012;13:599–600.CrossRefPubMed
Metadaten
Titel
Neonatal Lymphatic Flow Disorder
verfasst von
Handan Hakyemez Toptan
Elif Ozalkaya
Nilgun Karadag
Sevilay Topcuoglu
Emre Dincer
Guner Karatekin
Publikationsdatum
11.04.2023
Verlag
Springer India
Erschienen in
Indian Journal of Pediatrics / Ausgabe 3/2024
Print ISSN: 0019-5456
Elektronische ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-023-04531-x

Neu im Fachgebiet Pädiatrie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

ADHS-Kranke verlieren sieben Lebensjahre

  • 11.02.2025
  • ADHS
  • Nachrichten

Ein ADHS verkürzt die Lebenserwartung um rund sieben Jahre, bei Frauen sind es sogar fast neun Jahre. Ein Großteil der erhöhten Sterblichkeit lässt sich auf modifizierbare Risikofaktoren wie Alkohol, Rauchen und psychische Begleiterkrankungen zurückführen.

Abdominale CT bei Kindern: 40% mit Zufallsbefunden

Wird bei Kindern mit stumpfem Trauma eine CT des Bauchraums veranlasst, sind in rund 40% der Fälle Auffälligkeiten zu sehen, die nichts mit dem Trauma zu tun haben. Die allerwenigsten davon sind klinisch relevant.

Steigende Zahl von Skorbut-Fällen bei Kindern

Eine Erkrankung, die eigentlich der Vergangenheit angehören sollte, scheint in reichen westlichen Nationen wieder häufiger aufzutreten: Seit der Coronapandemie steigt bei Kindern und Jugendlichen in Frankreich die Inzidenz von Skorbut.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.