Özmert Muhammet Ali ÖZDEMİR, Hacer ERGİN, Kazım KÜÇÜKTAŞÇI, Özlem ŞAHİN, Nergül ÇÖRDÜK, Eda KARADAĞLI, Başak YILDIRIM

Oktreotid ile Tedavi Edilen Konjenital Şilotoraks Olgusu

Konjenital şilotoraks plevra boşluğunda şilöz sıvı birikmesidir. Yenidoğan döneminde plevral efüzyonun en sık sebebidir. Şilotoraksın geleneksel tedavisi konservatiftir. Konservatif tedavi göğüs drenajı, anne sütünün kesilmesi, orta zincirli trigliserid içeren formula veya total parenteral nutrisyon uygulanmasıdır. Son yıllarda şilotoraks tedavisinde uzun etkili somatostatin analoğu olan ve lenfatik sıvı üretimini azaltarak etki gösteren oktreotid, yeni tedavi seçeneği olarak kullanılmaktadır. Prenatal ultrasonografide sağ akciğerde plevral efüzyon saptanan term bebekte, doğum sonrası konjenital şilotoraks tanısı kesinleştirildi. Öncelikle göğüs tüpü uygulandı, daha sonra orta zincirli trigliseridden zengin formula başlandı. Şilöz sıvı birikimi azalmayan olguya subkutanöz oktreotid tedavisi uygulandı ve yan etki görülmeden şilotoraks tedavi edildi. İnatçı şilotoraks olgularında cerrahi uygulamaya alternatif, umut verici bir tedavi seçeneği olan oktreotid, yenidoğan bebeklerde güvenle kullanılabilmektedir

Anahtar Kelimeler:

Konjenital şilotoraks, oktreotid

A Case of Congenital Chylothorax Treated with Octreotide

Congenital chylothorax, an abnormal accumulation of chylous fluid in the pleural space, is a common cause of pleural effusion in the neonatal period. The traditional management of chylothorax is conservative. Conservative therapy includes chest drainage, cessation of breast feeding, and using of medium chain triglycerides or total parenteral nutrition. Recently, octreotide, a long-acting somatostatin analog reduced lymphatic fluid production, has been used as a new treatment strategy in the therapy of chylothorax. In a full term newborn with right pleural effusion diagnosed by prenatal ultrasound, congenital chylothorax is confirmed after birth. This patient was initially treated with chest tube insertion. Afterward a mediumchain-triglyceride-enriched formula was initiated. Subcutaneous octreotide was administered to the patient because of non-responded to conservative therapy. The chylothorax resolved promptly with no observed side effects. Octreotide appears to have a good safety drug in newborn infants and remains a promising alternative therapy to surgery for intractable cases with chylothoraces

Keywords:

Congenital chylothorax, octreotide,

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1. Wolff AB, Silen ML, Kokoska ER, Rodgers BM. Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children. Ann Thorac Surg 1999;68:1053-7.
2. Shah D, Sinn JK. Octreotide as therapeutic option for congenital idiopathic chylothorax: a case series. Acta Paediatr 2012;101:151- 5.
3. Rasiah SV, Oei J, Lui K. Octreotide in the treatment of congenital chylothorax. J Paediatr Child Health 2004;40:585-8.
4. Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev 2010;8:CD006388.
5. Kaneko M, Kanai Y, Go H, Imamura T, Momoi N, Hosoya M. Five cases of congenital chylothorax treated by intrapleural minocycline. AJP Rep 2012;2:25-8.
6. Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 2004;93:220-4.
7. Horvers M, Mooij CF, Antonius TA. Is octreotide treatment useful in patients with congenital chylothorax? Neonatology 2012;101:225-31.
8. Çelik M, Bülbül A, Uslu S, Sever N, Can E. Yenidoğan şilotoraks tedavisinde oktreotid kullanımı: Olgu sunumu. Ş.E.E.A.H. Tıp Bülteni 2012;46:26-9.
9. Moreira-Pinto J, Rocha P, Osorio A, Bonet B, Carvalho F, Duarte C, et al. Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review. Pediatr Surg Int 2011;27:805-9.
10. Foo NH, Hwang YS, Lin CC, Tsai WH. Congenital chylothorax in a late preterm infant and successful treatment with octreotide. Pediatr Neonatol 2011;52:297-301.