Report of a case of neonatal chylothorax that responded to long-term octreotide treatment, and review of the literature

Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. Morbidity of congenital chylothorax (CC) is high, and prognosis is very poor if CC is associated with hydrops fetalis. Although the optimal treatment of CC has not been determined, conservative treatment and surgical intervention are employed. However, there is still little experience with the use of octreotide therapy for this condition, and optimal duration of the treatment for response evaluation is not known. We report a newborn with CC who presented with intrauterine bilateral pleural effusion and was resistant to conservative treatments. Octreotide (6 µg/kg/h) infusion was started on the 10th postnatal day due to ongoing pleural drainage. Although the patient improved rapidly with continuous administration of octreotide, we had to continue the drug for 151 days, even subcutaneously on outpatient follow-up. To the best of our knowledge, this patient is unique in receiving octreotide treatment for such a long time, with a successful outcome and a safe profile.

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1. Bulbul A, Okan F, Nuhoglu A. Idiopathic congenital chylothorax presented with severe hydrops and treated with octreotide in term newborn. J Matern Fetal Neonatal Med 2009; 22: 1197-1200.

2. Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev 2010; (9): CD006388.

3. Coulter DM. Successful treatment with octreotide of spontaneous chylothorax in a premature infant. J Perinatol 2004; 24: 194-195.

4. Bellini C, Ergaz Z, Radicioni M, et al. Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisited. A multicenter retrospective study. Lymphology 2012; 45: 91-102.

5. Shah D, Sinn JK. Octreotide as therapeutic option for congenital idiopathic chylothorax: a case series. Acta Paediatr 2012; 101: 151-155.

6. Horvers M, Mooij CF, Antonius TA. Is octreotide treatment useful in patients with congenital chylothorax? Neonatology 2012; 101: 225-231.