Article Text

LONG TERM OCTREOTIDE FOR CONGENITAL CHYLOTHORAX
  1. C Gupta1,
  2. I Okike2,
  3. G Marais3
  1. 1NICU, Royal Jubilee Maternity Hospital, Belfast, N. Ireland, UK
  2. 2NICU, St. Heliers Hospital, UK
  3. 3NICU, Mayday University Hospital, Croydon, UK

Abstract

Background Chylothorax is the most common cause of pleural effusion causing respiratory distress in the neonate 3. Conservative management includes drainage through a chest drain and dietary fat restriction. Cases have been reported where surgery was avoided with use of octreotide1, 2. The duration of treatment ranged from 3 to 29 days, with a mean of 11 days 5. In our case, it was successfully used for 76 days. To date this is the longest duration reported. No adverse effects were noted in the short term.

Short report JE was found to have increased nuchal translucency at 14 weeks and a small pericardial effusion at 20 weeks on ultrasound antenatally. At 30 weeks there was a right sided pleural effusion requiring a pleuro-amniotic shunt. He was born at 31 weeks gestation with a birth weight of 2020 grams. He required ventilation for 6 days and then nCPAP for 90 days. He had bilateral pleural effusions at birth and chest drains were inserted that drained serous fluid. Monogen was started on day 8. The drains were removed when fluid drainage ceased. However, fluid reaccumulated, requiring several pleural taps before a subcutaneous Octreotide infusion was started at 20 mcg/kg/day on day 45 of life. Because of the recurring pleural effusions, Octreotide was further increased to 60 mcg/kg/day. It was slowly weaned and finally stopped on day 121 of life. CT scan of the chest done at day 120 of life suggested the possibility of pulmonary lymphangiectasia which had clinically and radiologically resolved.

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