Neonatal Effusion Research Articles

Pleurodesis using OK-432 for persistent pleural effusion after cardiac surgery in the neonatal period or early infancy.

To evaluate the efficacy of pleurodesis using OK-432 after cardiac surgery in the neonatal period or early infancy. We retrospectively reviewed the data of 11 consecutive patients who underwent cardiac surgery in the neonatal period or early infancy and pleurodesis using OK-432 for persistent postoperative pleural effusion in two institutions. The median age at surgery was 8 days (interquartile range [IR], 2-18) with a body weight of 2.84 kg (IR, 2.30-3.07). The maximum amount of pleural drainage before pleurodesis was 94.7 (IR, 60.2-107.7) ml/kg/day. Pleurodesis was initiated at postoperative day 20 (IR, 17-22) and performed in bilateral pleural spaces in seven patients and unilateral in four. The median numbers of injection were 4 (IR, 3-6) times per patient and 3 (IR, 2-3) times per pleural space. In 10 patients, pleural effusion was decreased effectively, and drainage tubes were removed without reaccumulation within 15 (IR, 12-28) days after initial pleurodesis. However, in one patient, with severe lymphedema, pleural effusion was uncontrollable, resulting in death due to sepsis. Adverse events were observed in nine patients; temporal deterioration of lung compliance and arterial blood gas occurred in two, insufficient drainage requiring new chest tube(s) in five, temporal atrial tachyarrhythmia in one, and lymphedema in four. Pleurodesis using OK-432 is effective and reliable for persistent postoperative pleural effusion in neonates and early infants. Most of the complications, which derived from inflammatory reactions, were temporary and controllable. However, severe lymphedema is difficult to control.

Hypertonic glucose pleurodesis for preterm neonates with chylothorax.

Chylothorax is a known complication of postcardiac surgery and the most common cause of pleural effusion in neonates. Conservative management is usually adopted, including Nil-per-Oral (NPO), treatment of underlying etiology of infection, and use of octreotide. Chylothorax resistant to medical therapy and drainage is often treated by chemical pleurodesis. Previously used pleurodesis agents have included talc, minocycline, OK-432, bleomycin, and povidone-iodine. 50% Dextrose (D50) has been reported to be useful for pleurodesis in adults. We successfully managed two cases of prematurely born infants with D50 as an alternative chemical sclerosant for chemical pleurodesis in a resistant chylothorax and discussed evidence of its use in the literature.

CONGENITAL CHYLOTHORAX –SUCCESSFUL MANAGEMENT WITH CHEMICAL PLEURODESIS

Congenital chylothorax in newborn is a rare disease but a common cause of pleural effusion in neonate. We report a case of congenital chylothorax associated with congenital heart disease in a term baby managed with intercostal drainage, octrotide and chemical pleurodesis.

ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE

Objective: This study aimed to investigate the possible complications, outcomes and course of ultrasonography (USG)-guided percutaneous pleural effusion drainage (PEPED) treatment with underlying etiology of effusion in neonates and infants. Material and Methods: In 31 patients aged 0-2 years hospitalized in the neonatal or pediatric intensive care unit, 45 catheters were inserted for USG-guided PEPED in a total of 40 sessions. Of these, a 6.3F 25 cm pigtail drainage catheter was inserted in 23 (57.5%) of our patients using the Seldinger method and in 17 (42.5%) using the trocar method. The sample fluid was biochemically classified as transudate, exudate, empyema and chylothorax. The duration of inserted catheter and type of fluid was studied along with etiological reasons for effusions. Results: Of our 31 patients, 17 were male (54.8%) and 14 were female (45.2). The weeks of birth ranged from 25.1 to 41 weeks, with a mean of 35.55±4.22 weeks. The retention time of drainage catheters ranged from 1 to 18 days, with a mean of 6.5±4.02 days. We compared the retention time of inserted catheters between different preterm and mature groups. Besides, the various fluid characters in the postoperative patient group were compared in the context postoperative day period. Conclusion: Catheter dwell time does not change with different levels of neonatal maturity. In neonates and infants with a history of surgery, the effusion transforms into chylothorax from hemothorax over time. Bedside USG-guided PEPED treatment for refractory pleural effusion in neonates and infants is highly safe and effective with low complication rates.

Idiopathic Chylothorax in a Term Neonate and Successful Treatment with Octreotide and Medium Chain Triglyceride -Enriched Formula: A Case Report

Background Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space secondary to leakage from thoracic duct or one of its main tributaries. Congenital idiopathic chylothorax is the most common form of pleural effusion in neonates. Conservative therapy is the mainstay of treatment. An alternative therapy is Octreotide, which is a long-acting somatostatin analog that can reduce lymphatic fluid production. It has been used for the treatment of chylothorx in children, but it is used as a new strategy for the treatment of chylothorax in neonates. Case Report We herein report a case of idiopathic unilateral chylothorax in a 3-day-old Iranian male neonate who was treated successfully with conservative therapy, octreotide and regimen therapy with medium-chain triglyceride (MCT)-enriched formula. Conclusion Chylothorax may be suspected in patients with pleural effusions. Pleural fluid triglyceride measurement remains the recommended diagnostic method in chylothorax

Causes and manifestations of chylothorax in children in China: Experience from a children's medical center, 2007-2017.

ImportanceChylothorax is the most common cause of pleural effusion in neonates and relatively rare in children. It can cause significant respiratory morbidity. Many clinical entities may contribute to chylothorax.ObjectiveTo investigate the causes and manifestations of chylothorax in infants and children in China.MethodsCase records of 107 cases with chylothorax seen in Beijing Children's Hospital from 2007 to 2017 were retrieved and analyzed; follow‐up was carried out by telephone.ResultsOf 107 cases, 58.9% (63/107) were primary chylothorax (PC) and 41.1% (44/107) were secondary chylothorax (SC). Also, 36.4% (39/107) were neonatal chylothorax (NC) and 35.5% (38/107) were postoperative chylothorax. In PC with a verified lymphatic anomaly, there was one case of diffuse pulmonary lymphangiomatosis (DPL) and six cases of generalized lymphatic anomaly (GLA), which accounted for 6.5% (7/107) of cases. In most patients, chylothorax was alleviated by conservative treatment based on total parenteral nutrition (TPN); 13.1% (14/107) of cases needed further surgery. In NC, the median duration of TPN was 9 days, but 10 of 20 cases who improved had recurrence upon re‐introduction of a fat‐free diet, which was alleviated by further TPN. The duration of hospitalization was (23 ± 14) days for congenital chylothorax. Upon long‐ term follow‐up, except for GLA and DPL, most patients were doing well without recurrence.Interpretation NC and postoperative chylothorax are the common subtypes. TPN is effective for most patients. Despite a prolonged and fluctuating clinical course, most patients had a good long‐term prognosis.

Neonatal bilateral chylothorax treated by octreotide

Chylothorax is a type of abnormal leak and accumulation of lymphatic fluid in the pleural space. Although clinically rare, chylothorax is the most common cause of pleural effusion in neonates and is usually idiopathic in nature. Chylothorax causes significant respiratory problems as well as nutritional and immunological issues. Patients unresponsive to medical management usually require a surgical intervention such as pleurodesis. We report the case of a full-term infant with an idiopathic bilateral chylothorax who was treated with octreotide (a long-acting somatostatin analogue) after failure of conservative nutritional management. The infant responded well and tolerated the medication without complications.

Congenital Idiopathic Bilateral Chylothorax in a Preterm Neonate

Congenital chylothorax is the most common cause of pleural effusion in neonates. It is defined as abnormal accumulation of chyle or lymphatic fluid in the pleural cavity. Exact incidence of chylothorax in neonates is unknown. Among the several causes of chylothorax idiopathic cause has the highest incidence. Chylothorax carries a high morbidity in terms of pulmonary complications, nutritional deficiencies, and immunodeficiency and also has a significant mortality rate. Here we report a 33 weeks preterm neonate with bilateral chylothorax which was treated with bilateral thoracentesis and octreotride therapy

Octreotide for the Management of Chylothorax in newborns, case report

Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT) or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.

Chemical pleurodesis using a Viscum album extract in infants with congenital chylothorax

Congenital chylothorax is a rare condition, but it is the most common cause of pleural effusion in neonates and infants. Here, we report on the first trials of the intrapleural instillation of an extract of Viscum album (European mistletoe) (Abnobaviscum Q®) in two infants with congenital chylothorax that was refractory to standard conservative management and thoracic duct ligation. The clinical course of both children improved with no side effects related to the extract after following up the children for 2 years and 9 months, respectively. Randomized multicenter prospective studies will help determine the effectiveness of pleurodesis with a V. album extract and the occurrence of long-term side effects with this agent.

Critical cardiac tamponade in newborn, life-saving emergency interventions and possibility of parvovirus B19 congenital infection

Abstract The presence of pericardial effusion in neonates usually indicates a poor prognosis. Here, we report a case of isolation of cardiac tamponade in a newly born. This may be related to vertical human parvovirus B19, an infection with atypical clinical manifestation. Any neonate with unexplained fetal pericardial effusion should always be tested for parvovirus B19 infection, even in the absence of known and proved fetal exposure. Despite the etiology of a tamponade the only reasonable procedure is a surgical evacuation during diagnosis.

Diagnosis of Middle Ear Effusion in Neonate and Infant: Pitfalls of Conventional Impedance Audiometry Using 226 Hz Probe Tone

Received April 15, 2012 Accepted June 20, 2012 Address for correspondence Jun Ho Lee, MD, PhD Department of Otorhinolaryngology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel +82-2-2072-2445 Fax +82-2-745-2387 E-mail junlee@snu.ac.kr Middle ear effusion is one of the most common causes which results in refer on hearing screening of infants. Evaluation of middle ear state has been emphasized because the causes and severity of hearing impairment determine the manner of rehabilitation. As a complimentary diagnostic method of middle ear effusion, tympanometry using 226 Hz probe tone has been most commonly used in adult and older children. However, recent reports have indicated obviously that the use of a 1000 Hz tympanometry is more reliable in younger infants and neonates than 226 Hz. This attributes to the developmental changes in acoustic properties and anatomic changes of middle ear structures and ear canal. Given the data reported up to the present, 1000 Hz tympanometry is recommended to diagnose middle ear effusion in children younger than 6 months. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:410-4 Key WordsZZImpedance audiometry ᆞInfants ᆞMiddle ear ᆞNeonate ᆞTympanometry.

Pericardial Effusion in a Preterm Infant Resulting from Umbilical Venous Catheter Placement

Pericardial effusion in neonates is a rare occurrence associated with malpositioning of central venous catheters. This report describes a case of pericardial effusion in which echocardiographic determination of line position, typically considered one of the most reliable means of placement verification, was misleading. The infant ultimately did well after pericardiocentesis, with complete resolution of symptoms and no further complications.

Early-onset pneumothorax indicates poor outcome in newborns with congenital idiopathic chylothorax

Chylothorax, defined as effusion of lymph into the pleural cavity, is the most common congenital pleural effusion in neonates.1 2 Advances in prenatal diagnosis, antenatal treatments, and improvements in neonatal...

Inflammation of Embryonic Connective Tissue in the Middle Ear Spaces

Objective --Persistent embryonic connective tissue has been considered to be a cause of chronic otitis media with effusion in neonates and of cholesteatoma in later life. As part of a study of pneumatization and resorption of embryonic connective tissue from the middle ear of pre- and postnatal infants, inflammatory processes of variable extents have been observed within the embryonic connective tissue. The aim of the present study was to characterize this inflammation and to detect patterns in its presence and distribution. Material and Methods --Twenty fetal temporal bones obtained at 4-8 months of development and 31 temporal bones from children who died of sudden infant death syndrome aged < 1 year were studied to assess the inflammation within the middle ear cleft and specifically in the embryonic connective tissue. Results --Sixteen of 27 (59.3%) pre- and 10/31 (32.2%) postnatal specimens displayed a non-specific inflammatory lymphocytic infiltration without signs of bacterial infection or the presence of or reaction to amniotic contents. Eleven of 27 prenatal temporal bones (40.7%) and 16/31 (51.6%) postnatal specimens showed no evidence of histologic middle ear inflammation. The presence or absence of inflammation was independent of age. Conclusion --Our observations indicate resorption of the embryonic connective tissue with individual variations indicating that genetic factors are responsible for the development of the middle ear spaces during the phases of development studied.

Tympanometry and otoacoustic emissions in a cohort of special care neonates.

Otoacoustic emission (OAE) screening and oto-admittance testing (678 Hz probe tone) were performed on both ears of 84 special care neonates, as part of a larger study of middle-ear effusion in neonates and infants. OAE results, tympanometry, and acoustic reflex results are all strongly and significantly associated. No evidence was found of any maturational effects in the results. Based on the findings, a tentative classification scheme for neonatal tympanograms is suggested. We conclude that 678 Hz tympanometry is a useful indicator of middle-ear status in very young babies, and that middle-ear effusion does strongly affect OAEs in neonates. OAEs are also strongly affected by negative middle-ear pressure (MEP), and mean MEP in ears failing OAE screens was significantly more negative than in those passing. The prevalence of abnormal tympanometry, which may indicate middle-ear effusion or dysfunction, was 20% of ears (29% of babies) in this group. It appears that middle-ear effusion could account for about half of the ears failing an OAE screen on the special care baby unit. We also find that length of stay on the special care baby unit is an important risk factor for development of middle-ear effusion: those on the unit for over 30 days have about four times the risk of bilateral abnormal tympanometry.