Spontaneous chylothorax in newborns
J. Van Aerde, A. N. Campbell, J. A. Smyth, D. Lloyd and M. H. Bryan
During a 22-year period, 12 cases of spontaneous chylothorax in newborns
were diagnosed at a large pediatric tertiary care center. Seven infants had
right-sided effusions; only one effusion occurred on the left. Severe
bilateral accumulations occurred in four nonimmune hydropic premature
infants. The diagnosis was made by the milky appearance and/or the presence
of more than 80% lymphocytes in the pleural fluid. Early diagnosis of the
pleural effusion as chyle was associated with a less protracted course than
when diagnosis was delayed. The total pleural fluid losses varied from 130
to 3,308 mL. Initial treatment included chest taps and/or drains in all the
infants and mechanical ventilation in six. Oral feedings with standard or
medium-chain triglyceride formulas were given in five; total parenteral
nutrition was administered in seven. The conditions of two infants with
copious and persistent drainage improved following surgery. All but one
infant survived, and the chylothoraxes never recurred.
