title: Massive chylothorax in small babies.
abstract: 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.
authors.affiliation: 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.
authors.forename: Katherine
authors.initials: K
authors.lastname: Cleveland
authors.forename: Diane
authors.initials: D
authors.lastname: Zook
authors.forename: Kayla
authors.initials: K
authors.lastname: Harvey
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
mesh_terms: 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
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives