title: Ventilation mode and outcome of premature infants with congenital chylothorax.
abstract: BACKGROUND
  Congenital chylothorax (CC) is a rare and potentially life-threatening condition. Over 50% occurs at birth and is considered as the most common cause of neonatal thoracic fluid collection.
  
  
  OBJECTIVE
  To analyse the main clinical and respiratory features of a contemporary group of CC infants.
  
  
  METHODS
  Databases for CC diagnosed between 2004 and 2009 were reviewed: 10 consecutive cases were retrieved and analysed.
  
  
  RESULTS
  Median gestational age of CC patients was 31.8 weeks. Most patients were diagnosed prenatally (7/10 pts, median GA at diagnosis 28 weeks). Severe respiratory distress at birth required respiratory support: 7/10 newborns received high-frequency oscillatory ventilation (HFOV) electively. Large effusions and/or early-onset pneumothorax did not influence the outcome, while prematurity did not impact significantly on mortality (death rate <33 weeks: 28%). The overall ICU survival rate was 70%.
  
  
  CONCLUSIONS
  CC still carries a significant risk of perinatal mortality. Continuous advances in foetal/neonatal medicine and intensive care have considerably improved the prognosis in the last decades, mostly in critically ill infants. HFOV improves lung opening and volume maintenance, possibly shortening the lymph flow over time. It can play a fundamental role both to prevent hypoxic and chronic lung damage and to improve lung recruitment in neonates born with CC.
authors.affiliation: Neonatal Intensive Care Unit, “S. Pietro Fatebenefratelli” Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Consigli
authors.forename: A
authors.initials: A
authors.lastname: Tempera
authors.forename: C
authors.initials: C
authors.lastname: Alegiani
authors.forename: M
authors.initials: M
authors.lastname: Spinelli
authors.forename: E
authors.initials: E
authors.lastname: Scapillati
authors.forename: C
authors.initials: C
authors.lastname: Haass
authors.forename: M
authors.initials: M
authors.lastname: Finocchi
authors.forename: E
authors.initials: E
authors.lastname: Luca
authors.forename: E
authors.initials: E
authors.lastname: Stival
authors.forename: D
authors.initials: D
authors.lastname: De Luca
authors.forename: M
authors.initials: M
authors.lastname: Piastra
mesh_terms: D002916:Chylothorax / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006612:High-Frequency Ventilation / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D007385:Intermittent Positive-Pressure Ventilation / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome