title: Octreotide for the treatment of chylothorax in neonates.
abstract: BACKGROUND
  Routine care for chylothorax in neonate includes either conservative or surgical approaches. Octreotide, a somatostatin analogue, has been used for the management of patients with refractory chylothorax not responding to conservative management.
  
  
  OBJECTIVE
  To assess the efficacy and safety of octreotide in the treatment of chylothorax in neonates.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (to March 7, 2010). We assessed the reference lists of identified trials and abstracts from the annual meetings of the Pediatric Academic Societies published in Pediatric Research (2002 to 2009) without language restrictions.
  
  
  METHODS
  We planned to include randomised or quasi-randomised controlled trials of octreotide in the treatment of congenital or acquired chylothorax in term or preterm neonates, with any dose, duration or route of administration.
  
  
  METHODS
  Data on primary (amount of fluid drainage, respiratory support, mortality) and secondary outcomes (side effects) were planned to be collected and analysed using mean difference, relative risk and risk difference with 95% confidence intervals.
  
  
  RESULTS
  No randomised controlled trials were identified. Nineteen case reports of 20 neonates with chylothorax in whom octreotide was used either subcutaneously or intravenously were identified. Fourteen case reports described successful use (resolution of chylothorax), four reported failure (no resolution) and one reported equivocal results following use of octreotide. The timing of initiation, dose, duration and frequency of doses varied markedly. Gastrointestinal intolerance and clinical presentations suggestive of necrotizing enterocolitis and transient hypothyroidism were reported as side effects.
  
  
  CONCLUSIONS
  No practice recommendation can be made based on the evidence identified in this review. A prospective registry of chylothorax patients and a subsequent multicenter randomised controlled trial are needed to assess the safety and efficacy of octreotide in the treatment of chylothorax in neonates.
authors.affiliation: Department of Pediatrics, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
authors.forename: Animitra
authors.initials: A
authors.lastname: Das
authors.forename: Prakeshkumar S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D002916:Chylothorax / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D015282:Octreotide / Q000627:therapeutic use*
chemical_list: D015282:Octreotide