Background and aims There is scant literature describing the evolution and management of congenital pleural effusions with most focus on Octreotide.¹ We present 15-year case series in a tertiary centre to add to this literature and to contribute to the development of a clinical guideline.

Methods Cases were identified from unit and regional abnormality survey databases. We included effusions detected antenatally or developing within 28 days between January 2000 and May 2015. We excluded intra-uterine deaths, still-births, termination of pregnancies and those which resolved antenatally. Data were available for 21/23 eligible cases.

Results43% died, mainly from early respiratory failure (median age at death 1 day) but later deaths occurred up to 57 days. The 83% of babies whose drainage resolved without octreotide or MCT formula, did so at a median age of 4 Days (range <1–9 days).² babies with chylothorax had outputs that did not spontaneously resolve; 1 was given octreotide at day 10 and both started MCT formula, at 17 and 4 days respectively.

Conclusions 83% of survivors had drainage that was self-limiting (lasting 9 days or less, drain outputs < 100 mls/Kg/Day). A second distinct group of confirmed chylothorax had outputs up to 200 mls/Kg/Day, lasting up to 3 weeks. Given this separation between groups we now recommend Octreotide/MCT if drainage persists >9 days.

References

1. Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. In: Shah PS, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd 2010. doi:10.1002/14651858. CD006388.pub2

2. Al-Tawil K, Ahmed G, Al-Hathal M, et al. CONGENITAL CHYLOTHORAX. Amer J Perinatol 2000; 17:121–6. doi:10.1055/s-2000-9281

3. Brissaud O, Desfrere L, Mohsen R, et al. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). Arch Dis Child – Fetal Neonatal Ed 2003; 88 :F531–3. doi:10.1136/fn.88.6. F531