Massive chylothorax in small babies.
OBJECTIVE
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.


CONCLUSIONS
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.
Cleveland
Katherine
K
Mary Bridge/Swedish Pediatric Cardiothoracic Surgery Program, Mary Bridge Children's Health Center, PO Box 5299, M/S 311-1-CTS, Tacoma, WA 98415, USA.
Zook
Diane
D
Harvey
Kayla
K
Woods
Ronald K
RK
D002916:Chylothorax / Q000601:surgery / Q000628:therapy*; D004322:Drainage; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D008026:Ligation; D018700:Pleurodesis; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000601:surgery; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives