G. Rollo, A. Zarfati, G. Burini, L. Valfre, C. Iacusso, I. Capolupo, B. D. Iacobelli, P. Bagolan, A. Conforti, F. Fusaro
Bambino Gesù Children’s Hospital IRCCS.
Italy
Pediatric Pulmonology
Pediatr Pulmonol 2025; 60:
DOI: 10.1002/ppul.71311
Abstract
Aims: The aim of our study was to review our experience regarding the management of neonatal chylothorax, with particular focus on outcomes of partial responders.
Methods: We conducted a retrospective analysis of neonatal chylothorax cases between January 2015 and December 2023. First-line management included drainage, fasting, parenteral nutrition, and octreotide. Good responders had a drainage output of <2 ml/kg/day after 1 week; partial responders had 2-10 ml/kg/day, and non-responders had >10 ml/kg/day or >100 ml/day for 5 days with complications. Partial responders continued conservative management, while non-responders received second-line treatment with bedside iodopovidone chemical pleurodesis.
Results: Thirty-five newborns (15 females, 20 males) were diagnosed with chylothorax, 11 congenital and 24 acquired (18 CDH, 5 esophageal atresia, 1 caval thrombosis). After first-line treatment, 7 (20%) were good responders, 19 (54%) were partial responders, and 9 (26%) were non-responders. Non-responders received iodopovidone pleurodesis, which resolved the condition in all cases (median time to resolution was 4 days). Complications during hospitalization included 8 cases of sepsis (1 fatal), 5 of atelectasis (4 related to pleurodesis), and 4 venous thromboses. Partial responders had significantly more sepsis (p = 0.029) but less atelectasis (p = 0.025) compared to non-responders, with similar resolution times and hospital stays. After a median follow-up of 3 years, there were no recurrences or thyroid dysfunction in the iodopovidone group.
Conclusions: First-line conservative management, although initially appropriate, can lead to serious morbidity if prolonged. Timely second-line treatment for partial responders with low-output chylothorax can minimize morbidity and mortality. Bedside chemical pleurodesis with iodopovidone is a safe and effective second-line treatment for refractory neonatal chylothorax.
Category
Primary Pulmonary Lymphatic Disease
Medical Therapy. Efficacy or Lack of Efficacy
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes