ABSTRACT
The objective of this paper is a retrospective study of all infants treated for congenital
chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King
Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts
of all infants with congenital chylothorax admitted to RCH over a period of 13 years,
June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August
1998 inclusive, were reviewed including management outcome and complications. There
were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants
were managed antenatally. Fifteen infants presented immediately after birth. Seven
were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely.
Regular infant feeding formula and/or breast milk were used successfully in 12 infants,
while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen
infants were mechanically ventilated with 75% of them ventilated for ≤ 28 days. Fifteen
infants received total parenteral nutrition (TPN), and in 80% for ≤ 32 days. Hydropic
infants had longer duration of mechanical ventilation and hospital stay with mean
(range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62)
and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with
failure in four. Sepsis and bronchopulmonary dysplasia were the main complications.
The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated
congenital chylothorax in term, and preterm infants is good even in the presence of
hydrops. Breast milk and/or regular infant feeding formula should be used initially
before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery
should be considered if conservative management of congenital chylothorax fails after
4-5 weeks.
KEYWORD
Congenital chylothorax - medium chain triglycerides rich formula - total parenteral
nutrition - bronchopulmonary dysplasia - hydrops fetalis
