ABSTRACT
BACKGROUND: Chylothorax is a rare disease, defined as an abnormal accumulation of chylous lymphatic effusion in thoracic cavity, with a high mortality rate in pediatric patients. At present, there are few studies on the treatment of pediatric chylothorax, and conservative treatments like somatostatin (SST) and pleurodesis are performed empirically. SST has been used for treating pediatric chylothorax over 20 years, and povidone-iodine chemical pleurodesis (PICP) is adopted in recent years with a high cure rate, but both the effect are still uncertain. The safety and efficacy of SST and PICP in treating pediatric chylothorax was compared in this study. METHODS: From January 2009 to May 2020, 27 pediatric chylothorax patients who accepted life support, SST and PICP treatment were retrospectively reviewed in this study. Their medical history, clinical manifestations, pleural effusion examinations, treatment methods, effects, and complications were screened. PICP and SST was performed in 19 and 8 children, respectively. Each patient was followed up after discharge from the hospital. RESULTS: After admission, chest X-ray and ultrasound diagnosed pleural effusion in 27 patients (18 males and 9 females), including 13 and 6 cases on the left and right side, and 8 cases on both sides. In the pleural effusion, the mean leukocyte count was (9,826±9,482)×106/L, the mean lymphocyte ratio was (84.82±6.58)%, the mean triglyceride content was 7.11±6.63 mmol/L. In PICP and SST group, the mean length of stay was 38.42±19.42 and 35.13±12.72 d (P=0.664), the mean time of thoracic drainage was 24.58±16.34 and 19.63±8.88 d (P=0.440), the mean time of parenteral nutrition was 27.16±18.29 and 25.25±13.52 d (P=0.793), respectively. PICP was performed for 3.16±2.27 times, and SST was used for 14.75±9.08 d with the dosage of 0.5 to 10 µg/kg/hour. After the treatment, all patients in PICP group had mild chest pain and low-grade fever, and 12 cases were observed with transient decrease of oxygen saturation. Eight patients in SST group had nausea and vomit, and 1 child had diarrhea simultaneously. Both were cured by symptomatic treatment, thoracic drainage and discontinuing using SST. Three children were diagnosed with refractory chylothorax and cured by PICP after SST. Pleural effusion in 27 patients was finally absorbed. All of them achieved a clinical cure successfully, and there was no recurrence during discharge follow-up. CONCLUSIONS: PICP has a high success rate and few adverse reactions in treating spontaneous chylothorax in pediatric patients, expected to be a new treatment option for pediatric chylothorax after SST.
ABSTRACT
BACKGROUND: Chylothorax is a rare disease with a high mortality rate in pediatric patients like newborns and infants. As one of the minimally invasive treatments, chemical pleural pleurodesis has been gradually used in treating pediatric chylothorax patients in recent years. This study explored the feasibility, safety and effect of povidone-iodine chemical pleurodesis (CP) for spontaneous chylothorax in young pediatric patients. METHODS: From January 2009 to December 2019 the clinical data of 22 children treated for spontaneous chylothorax at Guangdong Second Provincial General Hospital were retrospectively analyzed. The data included the patients' medical history, clinical manifestations, pleural effusion examinations, treatment methods, and effects and complications. On the basis of conventional conservative treatment and closed thoracic drainage, all the children were treated by CP with povidone-iodine until the pleural effusion was absorbed and the thoracic tube was removed. After discharge from the hospital, each patient was followed up for 1-10 years. RESULTS: Of the 22 children (16 males and 6 females), 3 cases were diagnosed with pleural effusion at prenatal examination, 5 cases had acute respiratory distress at birth, and 6 case had experienced pneumonia repeatedly since birth. All of the children had different degrees of cyanosis and dyspnea. Pleural effusion was diagnosed in all patients by chest X-ray and chest ultrasound after admission (12 cases on the left side, 5 cases on the right side, and 5 cases on both sides). The results of all chyle tests during pleural effusion examination were positive. The mean leukocyte count was (9,278.8±9,504.6)×106 /L, the lymphocyte ratio was (83.9±6.1)%, and the mean triglyceride content was (7.18±6.10) mmol/L. All patients were treated with thoracic drainage, diet control, nutritional support, and povidone-iodine CP, among 6 of them with pneumonia on admission received antibiotics. The mean length of stay (LOS) was (36.0±18.2) days. The patients received thoracic drainage for (23.0±15.6) days and pleurodesis (3.0±2.0) times. No serious side effects occurred after pleurodesis, although some patients experienced mild chest pain and low fever. All the patients successfully achieved a clinical cure. CONCLUSIONS: Povidone-iodine CP is a safe, effective, and minimally invasive treatment, with high success rate and few complications in young pediatric patients with spontaneous chylothorax.
