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A clinical study of congenital chylothorax and octreotide therapy

Korean Journal of Pediatrics 2008;51(11):1172-1178.
Published online November 15, 2008.
A clinical study of congenital chylothorax and octreotide therapy
Ung Geon Oh, Kyoung Eun Choi, Kyung Ah Kim, Sun Young Ko, Yeon Kyung Lee, Son Moon Shin
Department of Pediatrics, Cheil General Hospital & Women`s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
선천성 유미흉의 임상적 고찰과 옥트레오타이드 치료
오웅건, 최경은, 김경아, 고선영, 이연경, 신손문
관동대학교 의과대학 제일병원 소아청소년과
Correspondence: 
Kyung Ah Kim, Email: kkaped@medimail.co.kr
Abstract
Purpose
: Congenital chylothorax is an accumulation of lymphatic fluid within the pleural space. It is a common cause of unidentified hydrops fetalis. We examined the perinatal history, clinical manifestation, diagnosis, treatment, and outcome in 6 newborns diagnosed to have congenital chylothorax with hydrops fetalis. We also studied the effect of octreotide therapy for congenital chylothorax in relation to conservative treatment.
Methods
: We retrospectively reviewed the medical records of 6 patients diagnosed to have congenital chylothorax with hydrops fetalis among 27,907 newborns who were born at the Cheil General Hospital and Womens Healthcare Center between January 2004 and July 2007. The diagnosis of chylothorax is based on the analysis of pleural fluid before and after milk feeding.
Results
: Incidence of congenital chylothorax in this study was 0.021%. All 6 cases were noted in over the 92% lymphocyte in pleural analysis. Transudate was changed into chyle with increasing triglyceride levels above 200 mg/dL after milk feeding. Three of 6 infants improved with conservative treatment, including thoracostomy and assisted ventilation. The others had persistent symptoms despite conservative treatment and responded to octreotide therapy. A complication, specifically vomiting was noted in 1 case during octreotide therapy.
Conclusion
: In this study, octreotide therapy resulted in a safe and excellent outcome. Therefore, octreotide therapy is considered in severe refractory congenital chylothorax in conservative treatment. Further studies are required to determine appropriate guidelines for octreotide therapy.
Key Words: Congenital chylothorax, Octreotide, Hydrops fetalis, Clinical study


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