Octreotide in the treatment of congenital chylothorax

Abstract

Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the paediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage. Further studies are required to ascertain its true value in congenital chylothorax.

Successful Management of Congenital Chylous Ascites in a Premature Infant Using Somatostatin Analogue

“…In addition to adverse effects of nausea, diarrhea, fatty stools, transient abdominal distension, liver dysfunction and transient glucose disturbance reported in pediatric population [6], possible associations between administration of octreotide and occurrence of necrotizing enterocolitis [7], and pulmonary hypertension [8] have been noted in neonates, which were most likely attributable to its vasoconstrictive effect on splanchnic and pulmonary blood flow [9]. Hence, caution should be exercised in high-risk neonates with major cardiac malformations or bronchopulmonary dysplasia.…”

Caso Clínico Radiológico para diagnóstico

“…Otras técni-cas empleadas son el shunt pleuro-peritoneal, la pleurodesis y/o pleurectomía [16][17] . Por último, el Octreotide es un análogo de la somatostatina, cuyo mecanismo exacto de acción se desconoce, pero se cree que reduce el flujo linfático esplácnico y por ende del drenaje de quilo a la pleura, se ha usado con éxito relativo en casos de QT refractario al tratamiento convencional 18 . En general existe buena respuesta a la dieta pobre en grasa, siendo poco frecuente el uso de nutrición parenteral total y más raro aún el tratamiento quirúrgico.…”

Treatment of congenital chylothorax with octreotide in a hydropic preterm infant

“…2 Over the past 9 years, a number of case reports have supported the use of intravenous octreotide to treat chylothorax in infants and children. [3][4][5][6][7][8][9][10] However, its use in cases of congenital chylothorax in preterm infants is very limited as it is relatively rare. A preterm infant with hydrops fetalis who responded to octreotide is described.…”