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344 Chylothorax
Prognosis
Prognosis depends largely on the aetiology of the chylothorax. A
mortality rate of 12.8% among paediatric patients with a nontraumatic
chylothorax has been reported. This rate may be reduced by appropriate
support with TPN and timely intervention.
Evidence-Based Research
Table 55.2 presents a systematic review of using someatostatin or
octreotide as a treatment option for childhood chylothorax.
Table 55.2: Evidence-based research.
Title Somatostatin or octreotide as treatment options for chylo-
thorax in young children: a systematic review.
Authors Roehr CC, Jung A, Proquitte H, Blankenstein O, Hammer
H, Lakhoo K, Wauer RR.
Institution Department of Neonatology, Charité Campus Mitte,
Universitätsmedizin Berlin, Berlin, Germany; John Radcliffe
Hospital, Department of Paediatric Surgery, Oxford, UK.
Reference Intensive Care Med. 2006; 32(5):650–657. Epub 2006 Mar 11.
Problem Chylothorax is a rare but life-threatening condition in
children. To date, there is no commonly accepted treatment
protocol. Somatostatin and octreotide have recently been
used for treating chylothorax in children
Intervention Summarisation of the evidence on the efficacy and safety
of somatostatin and octreotide in treating young children
with chylothorax
Comparison/ Design: Systematic review: literature search (Cochrane
control (quality Library, EMBASE and PubMed databases) and literature
of evidence) hand search of peer reviewed articles on the use of soma-
tostatin and octreotide in childhood chylothorax. Patients:
Thirty-five children treated for primary or secondary chylo-
thorax (10/somatostatin, 25/octreotide) were found.
Outcome/effect Ten of the 35 children had been given somatostatin, as
intravenous (IV) infusion at a median dose of 204 μg/kg
per day, for a median duration of 9.5 days. The remaining
25 children had received octreotide, either as an IV infu-
sion at a median dose of 68 μg/kg per day over a median
7 days, or subcutaneous injection at a median dose of
40 μg/kg per day and a median duration of 17 days. Side
effects such as cutaneous flush, nausea, loose stools,
transient hypothyroidism, elevated liver function tests and
strangulation-ileus (in a child with asplenia syndrome) were
reported for somatostatin; transient abdominal distention,
temporary hyperglycaemia and necrotising enterocolitis (in
a child with aortic coarctation) for octreotide.
Historical A positive treatment effect was evident for both soma-
significance/ tostatin and octreotide in the majority of reports. Minor
comments side effects have been reported; however, caution should
be exercised in patients with an increased risk of vascular
compromise to avoid serious side effects. Systematic clini-
cal research is needed to establish treatment efficacy and
to develop a safe treatment protocol.

Key Summary Points

1. Chylothorax may be congenital or traumatic, most commonly 4. A somatostatin analogue may be tried before surgical
postoperative. intervention.
2. Diagnosis is by means of pleural tap analysis showing more 5. Surgery is reserved for the refractory chylothorax with either
than 80% lymphocytes on the differential count. direct ligation of the leak where feasible, ligation of the duct
and all periaortic tissues at the aortic hiatus, or utilisation of a
3. Optimum treatment includes chest tube drainage, nothing by pleuroperitoneal shunt.
mouth and nutritional support with total parenteral nutrition
(TPN). Feeding restricted to medium chain triglycerides may
be tried in the absence of TPN, and is often used once the
leak has subsided with the patient on TPN.