Clinical case: congenital chylothorax and chyloperitoneum in a premature newborn

Abstract

Congenital malformations of the heart and great vessels are found in 1% (1 in 100 newborns) among newborns. They are hold the second place after congenital malformations of the nervous system. One of these types of malformations are congenital malformations of the thoracic lymphatic duct. Unlike other anomalies of the great vessels, they are quite rare, and detected with a frequency of 1: 15000 newborns. A consequence of this prevalence of spontaneous chylothorax in newborns is a poorly understood problem in neonatology.Chylothorax is the most typical clinical manifestation of the thoracic lymphatic duct pathology, which is associated not only with congenital malformations. Nevertheless, the etiology and pathogenesis of spontaneous chylous effusion in newborns are unclear. Most often, chylothorax or chyloperitoneum occurs in premature infants.Today there are two ways of chylothrax treatment: conservative and surgical. In the past, for a long time, mortality from chylothorax has been 50-100%. Currently, with the introduction of modern methods of intensive care into practice, mortality from chylothorax in newborns, according to published data, has decreased to 30-50%, but remains quite high, which explains the significance of this pathology.The problem is also of clinical interest due to the small number of observations and the lack of a protocol for the management of chylothorax in newborns, especially in combination with chyloperitoneum and lymphedema.Nevertheless, this case report is interested due to achievement complete recovery of the patient, despite the pessimistic prognosis. The severity of the condition of the child required hospitalization in the neonatal intensive care unit and measures to support vital functions, drainage of the pleural cavity, octreotide infusion for 17 days, and chemical pleurodesis with 10% povidone-iodine solution.Analyzing this case, we noted the low efficiency of using only one particular method of therapy in the treatment of chylothorax and the rapid regression of symptoms after complex treatment, which was supplement with an invasive procedure - pleurodesis - in combination with the continuous administration of norepinephrine. Thus, due to this complex treatment this case distinguishes from standard recommendations.