Characterizing chylothorax in the pediatric population with Congenital Heart Disease

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BackgroundChylothorax is characterized by the accumulation of chyle in the pleural space which can occur post operatively in Congenital Heart Disease patients. Ongoing losses of chyle can promote malnutrition, immunosuppression, and can increase the risk of infection. ObjectivesTreatment type and length vary in the pediatric cardiac ward at The Royal Children's Hospital in Melbourne; therefore, this study aims to characterize the patient profile and management strategies of these patients who develop a chylothorax post cardiac surgery. MethodsA retrospective audit was conducted of 66 cardiac patients with chylothorax admitted to a tertiary pediatric cardiac ward between April 2016 and January 2018. Data was collected from the Electronic Medical Record at The Royal Children's Hospital in Melbourne, Australia. Data was examined for variables and analyzed using descriptive statistics. ResultsMost patients (26/66, 39 %) were infants, with an equal ratio between genders (1:1). Of the 15 patients with genetic anomalies, the majority had Trisomy 21 (6/15, 40 %). Nine percent of patients had vascular ring surgery (n = 6), with 78 % of patients having a sternotomy incision (n = 51). Most drain specimens appeared bloodstained (55 %, n = 36) and monogen was the most common treatment (71.2 %, n = 47). Average treatment duration and drain length insitu were 23 and 17.5 days, respectively, with most patients hospitalized for 7–31 days (52.3 %, n = 34). ConclusionsThis study provides novel insights into the baseline demographics of pediatric cardiac patients who develop chylothorax post operatively. This is invaluable data to form a basis for further research and interventions to develop best-practice clinical care of children post cardiac surgery. Already to date, this information has led to the development of a Clinical Practice Guideline for chylothorax management at The Royal Children's Hospital Melbourne and serves to further strengthen the limited repertoire of pediatric chylothorax patient profile knowledge currently available in the literature.