Conservative management of chylothorax in infants using octreotide

Abstract

Background: Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates and infants. Chylothorax causes respiratory and nutritional problems and has a significant mortality rate. Octreotide is a long-acting somatostatin analogue that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.Methods: Infants with spontaneous chylothorax over a period of 3 years were included in this study. A prospective, observational study was done. All patients were nil per oral initially. Oral feeds were resumed once the ICD output declined. Octreotide was given subcutaneously for all patients at a dose of 40 microgram/kg/day in 3 divided doses. Octreotide was stopped once the ICD output was less than 70-80 ml/day. ICD was inserted in all patients and removed once drainage was below 50 ml/day.Results: Five patients were diagnosed with chylothorax over a period of 3 years out of which 3 were male and 2 were females. 1 patient had right sided and 4 patients had left sided chylothorax. The average age of presentation was 5.6 months. Octreotide was administered for an average of 14.4 days (8-22 days). The average duration of ICD was 18.2 days. All patients recovered well and were discharged.Conclusions: Spontaneous chylothorax is rare in infants. Conservative management is usually successful. Early institution of oral feeds with octreotide preserves the child’s nutrition and avoids invasive procedures, such as reinsertion of chest tubes or surgery.