Evidence-based management of chylothorax in infants.
OBJECTIVE
Management guidelines for infants with chylothorax lack substantial evidence. We sought to identify variables that impact outcomes in these patients in order to develop an evidence-based management algorithm.


METHODS
We retrospectively reviewed the medical records of all infants diagnosed with chylothorax from June 2005 to December 2014 at our institution. Data collected included demographics, chest tube output (CTO), medical and dietary interventions, surgical procedures, and absolute lymphocyte count (ALC). Outcomes analyzed included death, sepsis, necrotizing enterocolitis (NEC), requiring surgery, and success of therapy, defined as CTO decrease by >50% within 7days.


RESULTS
Of 178 neonates with chylothorax, initial therapy was high medium chain triglyceride (MCT) feedings in 106 patients, nothing by mouth (NPO), total parenteral nutrition (TPN) in 21, and NPO/TPN plus octreotide in 45. Octreotide use in addition to NPO/TPN revealed no significant differences in any outcome including success (47% vs. 43%, p=0.77). Initial CTO and ALC correlated with needing surgery (p=0.002 and p=0.006, respectively), and with death (p=0.028 and p=0.043, respectively). ALC also correlated with sepsis (p<0.001).


CONCLUSIONS
Octreotide has no advantage over NPO/TPN alone in infants with chylothorax. CTO and ALC predict requiring surgery. We propose a management guideline based on CTO and ALC without a role for octreotide.


METHODS
Retrospective case-control study.


METHODS
3.
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: jchurc@med.umich.edu.
Joseph T
JT
Church
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Alexis G
AG
Antunez
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Ashley
A
Dean
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Niki
N
Matusko
Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Kristopher B
KB
Deatrick
Section of Neonatology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.
Mohammad A
MA
Attar
Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Samir K
SK
Gadepalli
D015505:Chest Tubes; D002916:Chylothorax / Q000628:therapy*; D003131:Combined Modality Therapy; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015282:Octreotide / Q000627:therapeutic use*; D010289:Parenteral Nutrition, Total; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide
Absolute lymphocyte count (ALC); Chylothorax; Octreotide