Neonatal Chylothoraces: A 10-Year Experience in a Tertiary Neonatal Referral Centre

Background. Neonatal chylothorax is a rare condition, but has a high mortality. Study Objectives. To analyse the outcomes of a series of neonates with chylothorax and review the literature to determine best practice. Design. A case series review and a literature review using electronic databases including the key words neonates and chylothorax. Results. Six cases of neonatal chylothorax were identified during a ten-year period, two had congenital chylothoraces and four iatrogenic chylothoraces after thoracic surgery or chest instrumentation. The neonates were ventilated for a median of 30 (range 13-125) days with a median maximum daily pleural fluid output of 218 (range 86-310) ml/kg/day. All the neonates were given medium-chain triglyceride (MCT) feeds which stabilised pleural fluid output in four and reduced it in another. Octreotide was used in three neonates, but the dosage used had no significant effect on pleural output. Two neonates required surgical intervention. The literature review demonstrated MCT feeds can reduce or stabilise pleural fluid output, but highlighted variable use of octreotide and inconsistent dosing regimens and outcomes. No consensus regarding indications for surgical intervention was identified. Summary and Conclusion. Neonatal chylothorax is uncommon, but affected neonates require high healthcare utilisation.