The role of somatostatin in the treatment of persistent chylothorax in children

Objective: To analyze the success rate of somatostatin in children with persistent chylothorax who failed dietary treatment options (fat-free nutrition, total parenteral nutrition) and to work out predictive factors for a successful therapy with somatostatin. Methods: Retrospective cohort study over a 5-year period (2000-2004) in a neonatal and pediatric intensive care unit of a tertiary university hospital. We analyzed the data of 85 neonatal and pediatric patients. Treatment of chylothorax occurred according to a multistage protocol with progressing invasiveness: (1) fat-free enteral nutrition, (2) total parenteral nutrition, (3) somatostatin infusion, (4) surgery. The percentages of patients successfully treated at the progressing steps were recorded. The somatostatin group was analyzed regarding to physiologic, diagnostic, treatment and outcome parameters. Somatostatin-responders were compared with non-responders. Results: Seventy-six of the 85 patients had chylothorax after cardiac surgery. Sixty-six percent could be treated with fat-free nutrition alone, 19% needed treatment with total parenteral. nutrition and in 15% somatostatin was added. Of the whole sample, 4.7% required a surgical intervention. Of the 13 patients treated with somatostatin, all had bilateral chylothorax. Six patients (46%) responded to somatostatin. Responders and non-responders did not differ significantly regarding age, day of postoperative diagnosis of chylothorax, amount of chylous effusion before somatostatin infusion, triglyceride concentration and lymphocyte percentage in chylous, and central venous pressure (p = 0.066). Conclusions: Somatostatin, integrated in a treatment algorithm, was successful in resolving persistent chylothorax in around 50% of patients. With this strategy, some children may be prevented from undergoing an operation. However, factors predicting successful therapy with somatostatin could not be elicited. (c) 2006 Elsevier B.V. All rights reserved.