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October 1984, Vol 138, No. 10 >
Article | October 1984

Spontaneous Chylothorax in Newborns FREE

Johny Van Aerde, MD; Alastair N. Campbell, MRCP; John A. Smyth, FRCP(C); David Lloyd, FRCP(C); M. Heather Bryan, FRCP(C)
[+] Author Affiliations

Reprint requests to Division of Neonatology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G1X8 (Dr Van Aerde).


Am J Dis Child. 1984;138(10):961-964. doi:10.1001/archpedi.1984.02140480063019.
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References
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• 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.

(AJDC 1984;138:961-964)

REFERENCES

1 +
Pisek G:  Report of a chylothorax . Arch Pediatr 1917;;34:929-937.
2 +
Stewart C, Linner H:  Chylothorax in a newborn infant . AJDC 1926;;31:654-656.
3 +
Hilgenburg F:  Ein Fall von chylothorax beim neugeborenen . Monatsschr Geburtsh Gynak 1929;;831:225-238.
4 +
Janet H, Boeger E, Laquerriere C:  Chylothorax chez le nouveau-né . Bull Soc Pediatr Paris 1936;;34:577-590.
5 +
Bessone L, Ferguson T, Burford T:  Chylothorax . Ann Thorac Surg 1971;;12:527-550.
6 +
Brodman R:  Congenital chylothorax: Recommendations for treatment . NY State J Med 1975;;75:553-557.
7 +
Vain N, Swarnel O, Cha C:  Neonatal chylothorax: A report and discussion of nine consecutive cases . J Pediatr Surg 1980;;15:261-265.
8 +
Green R, Hohnston R:  Pleural inflammation and pleural effusion , in Baum GI (ed): Textbook of Pulmonary Diseases . Boston, Little Brown & Co, 1974;, pp 959-982.
9 +
Hughes R:  Management of chylothorax . Chest 1979;;76:212-218.
10 +
Sardet A:  Chylothorax de l'enfant et du nouveau-né . Arch Fr Pediatr 1981;;38:455-459.
11 +
Chernick V, Reed M:  Pneumothorax and chylothorax in the neonatal period . J Pediatr 1970;;76:624-632.
12 +
McWilliams B, Fan L, Murphy S:  Transient T-cell depression in postoperative chylothorax . J Pediatr 1981;;99:595-597.
13 +
Wickham L, Smith F, Baden M:  New formula confuses old test . Pediatrics 1981;;68:470.
14 +
Randolph J, Gross R:  Congenital chylothorax . Arch Surg 1957;;74:405-419.
15 +
Perry R, Hodgman J, Cass A:  Pleural effusion in the neonatal period . J Pediatr 1963;;62: 838-843.
16 +
Hendren GW, Kim S:  Chylothorax , in Scarpelli E, Auld P, Goldman H (eds): Pulmonary Disease of the Fetus, Newborn and Child . Philadelphia, Lea & Febiger, 1978;, pp 206-207.
17 +
Doolittle W, Ohmart M, Egan E:  Congenital bilateral pleural effusions . AJDC 1973;;125: 435-437.
18 +
McKendry J, Lindsay W, Gerstein M:  Congenital defects of the lymphatics in infancy . Pediatrics 1957;;19:21-34.
19 +
Bornhurst R, Carsky E:  Fetal hydrothorax . Radiology 1964;;83:476-479.
20 +
Koffler H, Papille L, Burnstein R:  Congenital chylothorax: Two cases associated with maternal polyhydramnios . AJDC 1978;;132:638-639.
21 +
Yancy W, Spock A:  Spontaneous neonatal pleural effusion . J Pediatr Surg 1967;;2:313-319.
22 +
Yoss B, Lipsitz P:  Chylothorax in two mongoloid infants . Clin Genet 1977;;12:357-360.
23 +
Fischer E, Weiss E, Michals K, et al:  Spontaneous chylothorax in Noonan's syndrome . Eur J Pediatr 1982;;138:282-284.
24 +
Joyce L, Lindsay W, Nicholoff D:  Chylothorax after median sternotomy for intrapericardial cardiac surgery . J Thorac Cardiovasc Surg 1976;;71:476-480.
25 +
Siegler R, Pearch M:  Metabolic acidosis from the loss of thoracic lymph . J Pediatr 1978;; 93:465-466.
26 +
Brodman R, Zavelson T, Schiebler G:  Treatment of congenital chylothorax . J Pediatr 1974;;85:516-517.
27 +
Harvey J, Houlsby W, Sherman K, et al:  Congenital chylothorax: Report of a unique case associated with H-type tracheo-oesophageal fistula . Br J Surg 1979;;66:485-487.
28 +
Simmonds W:  The effect of fluid, electrolytes and food intake on thoracic duct lymph flow in unanaesthetized rats . Aust J Exp Biol Med Sci 1954;;32:285-291.
29 +
Barrowman J, Roberts K:  The role of the lymphatic system in the absorption of water from the intestine of the rat . Q J Exp Physiol 1967;;52: 19-29.
30 +
Craenen J, Williams T, Kilman J:  Simplified management of chylothorax in neonates and infants . Ann Thorac Surg 1977;;24:275-277.
31 +
Crandall L, Barker S, Graham D:  A study of the lymph flow from a patient with thoracic duct fistula . Gastroenterology 1943;;1:1040-1046.
32 +
Gershanik J, Johnsson H, Riopel D, et al:  Dietary management of neonatal chylothorax . Pediatrics 1974;;53:400-403.
33 +
Koloske A, Martin L, Schubert W:  Management of chylothorax in children by thoracocentesis and medium chain triglyceride feedings . J Pediatr Surg 1974;;9:365-371.
34 +
Peitersen B, Jacobsen B:  Medium chain triglycerides for treatment of spontaneous, neonatal chylothorax . Acta Paediatr Scand 1977;;66: 121-125.
35 +
Tamir I, Hunter J, Fosbrooke A, et al:  Serum and chyle lipids during medium chain triglyceride feeding in a child with chylothorax . Arch Dis Child 1968;;43:302-306.
36 +
Kramer S, Taylor G, Garfinkel D, et al:  Lethal chylothoraces due to superior vena caval thrombosis in infants . AJR 1981;;137:559-563.
37 +
Bensoussan A, Braun P, Guttman F:  Bilateral spontaneous chylothorax of the newborn . Arch Surg 1975;;110:1243-1245.

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References

1 +
Pisek G:  Report of a chylothorax . Arch Pediatr 1917;;34:929-937.
2 +
Stewart C, Linner H:  Chylothorax in a newborn infant . AJDC 1926;;31:654-656.
3 +
Hilgenburg F:  Ein Fall von chylothorax beim neugeborenen . Monatsschr Geburtsh Gynak 1929;;831:225-238.
4 +
Janet H, Boeger E, Laquerriere C:  Chylothorax chez le nouveau-né . Bull Soc Pediatr Paris 1936;;34:577-590.
5 +
Bessone L, Ferguson T, Burford T:  Chylothorax . Ann Thorac Surg 1971;;12:527-550.
6 +
Brodman R:  Congenital chylothorax: Recommendations for treatment . NY State J Med 1975;;75:553-557.
7 +
Vain N, Swarnel O, Cha C:  Neonatal chylothorax: A report and discussion of nine consecutive cases . J Pediatr Surg 1980;;15:261-265.
8 +
Green R, Hohnston R:  Pleural inflammation and pleural effusion , in Baum GI (ed): Textbook of Pulmonary Diseases . Boston, Little Brown & Co, 1974;, pp 959-982.
9 +
Hughes R:  Management of chylothorax . Chest 1979;;76:212-218.
10 +
Sardet A:  Chylothorax de l'enfant et du nouveau-né . Arch Fr Pediatr 1981;;38:455-459.
11 +
Chernick V, Reed M:  Pneumothorax and chylothorax in the neonatal period . J Pediatr 1970;;76:624-632.
12 +
McWilliams B, Fan L, Murphy S:  Transient T-cell depression in postoperative chylothorax . J Pediatr 1981;;99:595-597.
13 +
Wickham L, Smith F, Baden M:  New formula confuses old test . Pediatrics 1981;;68:470.
14 +
Randolph J, Gross R:  Congenital chylothorax . Arch Surg 1957;;74:405-419.
15 +
Perry R, Hodgman J, Cass A:  Pleural effusion in the neonatal period . J Pediatr 1963;;62: 838-843.
16 +
Hendren GW, Kim S:  Chylothorax , in Scarpelli E, Auld P, Goldman H (eds): Pulmonary Disease of the Fetus, Newborn and Child . Philadelphia, Lea & Febiger, 1978;, pp 206-207.
17 +
Doolittle W, Ohmart M, Egan E:  Congenital bilateral pleural effusions . AJDC 1973;;125: 435-437.
18 +
McKendry J, Lindsay W, Gerstein M:  Congenital defects of the lymphatics in infancy . Pediatrics 1957;;19:21-34.
19 +
Bornhurst R, Carsky E:  Fetal hydrothorax . Radiology 1964;;83:476-479.
20 +
Koffler H, Papille L, Burnstein R:  Congenital chylothorax: Two cases associated with maternal polyhydramnios . AJDC 1978;;132:638-639.
21 +
Yancy W, Spock A:  Spontaneous neonatal pleural effusion . J Pediatr Surg 1967;;2:313-319.
22 +
Yoss B, Lipsitz P:  Chylothorax in two mongoloid infants . Clin Genet 1977;;12:357-360.
23 +
Fischer E, Weiss E, Michals K, et al:  Spontaneous chylothorax in Noonan's syndrome . Eur J Pediatr 1982;;138:282-284.
24 +
Joyce L, Lindsay W, Nicholoff D:  Chylothorax after median sternotomy for intrapericardial cardiac surgery . J Thorac Cardiovasc Surg 1976;;71:476-480.
25 +
Siegler R, Pearch M:  Metabolic acidosis from the loss of thoracic lymph . J Pediatr 1978;; 93:465-466.
26 +
Brodman R, Zavelson T, Schiebler G:  Treatment of congenital chylothorax . J Pediatr 1974;;85:516-517.
27 +
Harvey J, Houlsby W, Sherman K, et al:  Congenital chylothorax: Report of a unique case associated with H-type tracheo-oesophageal fistula . Br J Surg 1979;;66:485-487.
28 +
Simmonds W:  The effect of fluid, electrolytes and food intake on thoracic duct lymph flow in unanaesthetized rats . Aust J Exp Biol Med Sci 1954;;32:285-291.
29 +
Barrowman J, Roberts K:  The role of the lymphatic system in the absorption of water from the intestine of the rat . Q J Exp Physiol 1967;;52: 19-29.
30 +
Craenen J, Williams T, Kilman J:  Simplified management of chylothorax in neonates and infants . Ann Thorac Surg 1977;;24:275-277.
31 +
Crandall L, Barker S, Graham D:  A study of the lymph flow from a patient with thoracic duct fistula . Gastroenterology 1943;;1:1040-1046.
32 +
Gershanik J, Johnsson H, Riopel D, et al:  Dietary management of neonatal chylothorax . Pediatrics 1974;;53:400-403.
33 +
Koloske A, Martin L, Schubert W:  Management of chylothorax in children by thoracocentesis and medium chain triglyceride feedings . J Pediatr Surg 1974;;9:365-371.
34 +
Peitersen B, Jacobsen B:  Medium chain triglycerides for treatment of spontaneous, neonatal chylothorax . Acta Paediatr Scand 1977;;66: 121-125.
35 +
Tamir I, Hunter J, Fosbrooke A, et al:  Serum and chyle lipids during medium chain triglyceride feeding in a child with chylothorax . Arch Dis Child 1968;;43:302-306.
36 +
Kramer S, Taylor G, Garfinkel D, et al:  Lethal chylothoraces due to superior vena caval thrombosis in infants . AJR 1981;;137:559-563.
37 +
Bensoussan A, Braun P, Guttman F:  Bilateral spontaneous chylothorax of the newborn . Arch Surg 1975;;110:1243-1245.

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