Pneumothorax and chylothorax in the neonatal period

Chernick, Víctor; Reed, Martin H.

doi:10.1016/s0022-3476(70)80420-6

Cited by 127 publications

(60 citation statements)

References 13 publications

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“…Congenital chylothorax occurs more commonly in males than in females (2:1), and it occurs more commonly on the right side (right, 53%; left, 35%; bilateral, 12%). 4 Acquired chylothorax results from damage to the thoracic duct. It has been reported as a surgical complication of the repair of the diaphragmatic hernia, tracheoesophageal fistula and a variety of congenital heart disorders.…”

Section: Introductionmentioning

confidence: 99%

The use of fat-free human milk in infants with chylous pleural effusion

Chan

Lechtenberg

2007

J Perinatol

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Objective: The purpose of this study is to describe the processing of human milk to remove its fat content and its use in seven infants with chylothorax.Study design: The mother's milk was centrifuged at 3000 r.p.m. for 15 min at 21C. After centrifugation, the milk separated into a solidified-fat top layer and a lower liquid portion. The fat-free liquid portion was then poured into collection cups and frozen for the patient's use at a later date. A sample of the mother's milk before and after processing was stored and analyzed for fat, sodium, potassium, calcium and zinc.Results: The mean fat removed was 5±1 g/dl (mean±s.d.), which was the same as the pre-fat content of the mother's milk. Seven infants with chylous pleural effusions used the fat-free human milk. All infants started on the fat-free milk after a month of age for an average of 16 days duration (7 to 34 days range). There was no reaccumulation of the chylous pleural effusions with the use of the fat-free mother's milk. Mother's milk electrolytes were similar before and after processing. Conclusion:Fat-free human milk may be an important additional dietary therapy for infants with chylothorax and may add the immunologic properties of human milk that other feedings cannot provide.

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Section: Introductionmentioning

confidence: 99%

The use of fat-free human milk in infants with chylous pleural effusion

Chan

Lechtenberg

2007

J Perinatol

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“…2 At birth, the infant develops respiratory distress; 50% of patients have symptoms within the first 24 hours, whereas 75% have symptoms by the end of the first week. 88 On physical examination, there is bilateral or unilateral dullness to percussion, and poor air entry. 89 Among patients with chronic chylothorax, muscle wasting, weight loss, and other signs of malnutrition can be present.…”

Section: Clinical Manifestations Of Chylothoraxmentioning

confidence: 99%

“…94 With congenital chylothorax, the pleural fluid is serous and becomes chylous when milk feedings are started. 88 Pleural fluid triglyceride and lipoprotein analysis should be performed in all newborns with pleural effusion. 1,88…”

Section: Diagnosis Of Chylothoraxmentioning

confidence: 99%

Chylothorax in Infants and Children

2014

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Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed. Pediatrics 2014;133:722-733

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“…Mechanical ventilator assistance was not a factor in his study. 11 Karlberg 12 recorded transpulmonary pressures during the first few breaths of life of 40 cm H 2 O and occasionally as high as 100 cm H 2 O. Chernick 4,13 noticed that adult alveoli would rupture at a pressure of approximately 60 cm H 2 O. Comparable data are not available for newborn infants.…”

Section: Mechanical Ventilation and Development Of Interstitial Emphymentioning

confidence: 99%

Pulmonary Interstitial Emphysema in a Full-Term Infant: Do We Know the Incidence?

Al-Mane

Salama

2003

Ann Saudi Med

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A Rejjal, Pulmonary Interstitial Emphysema in a Full-Term Infant: Do We Know the Incidence?. 2003; 23(3-4): 191-193 Pulmonary interstitial emphysema (PIE) occurs predominantly in premature infants exposed to mechanical ventilation. In the modern literature, pneumothorax is the most common form of air leak syndrome in full-term infants of average weight, while the incidence of PIE in the same age group is not known. We report a case of a fullterm infant who developed severe PIE secondary to aggressive conventional mechanical ventilation that responded to selective intubation and high frequency oscillatory ventilation. In addition, we review the incidence reported in the literature of PIE affecting full-term newborns. Case ReportA 3-day old full-term male infant, with a birth weight of 3.4 kilograms, was transferred from a district hospital because of deterioriation of respiratory function despite high mechanical ventilation requirements. The mother was a healthy, 35-year old (gravida 5, para 4) and a non-smoker. There was no maternal history to suggest infection. The family history was unremarkable. The infant was born by emergency cesarian delivery because of fetal distress and a thin meconium. The Apgar score was 6 at the first minute and 8 at the fifth minute. There was a minimal, thin meconium below the vocal cord on tracheal suctioning. The infant was showing signs of respiratory distress and was admitted to the neonatal intensive care for close monitoring.The infant's condition became worse and his FiO 2 requirement increased constantly with deterioration of arterial blood gas. He had to be intubated and conventional mechanical ventilation was initiated. A chest x-ray demonstrated a mild increase in bronchovascular markings, with no evidence of lung opacities. The infant's blood gas one hour after intubation was not improving and showed evidence of severe hypoxemia (PaO 2 of 30 mm Hg and PCO 2 of 42 mm Hg). Positive inspiratory pressure (PIP) was increased steadily until it was 37 cm H 2 O at 18 hours of age with anFiO 2 of 1 (100% oxygen) and a respiratory rate of 70per minute to maintain oxygen saturation between 85% to 90% on the monitor. At 24 hours of age, the ventilatory requirements increased and a chest x-ray showed evidence of diffuse pulmonary interstitial emphysema involving the whole left lung, complicatedshortly by tension pneumothorax that required chest tube insertion. On arrival at our NICU, the infant was extremely sick with unstable vital signs, an oxygen saturation of 80%, and severe metabolic and respiratory acidosis (pH of 7.1 and PaO 2 of 40 mm Hg, PCO 2 of 58 mm Hg and HCO 3 of 14 mm Hg). He was receiving mechanical ventilation with a PIP/PEEP (positive inspiratory and end-expiratory pressure) of 40/4 cm H 2 O, an inspiratory time of 0.7, and 100% oxygen. The infant was placed on high frequency oscillatory ventilation while inhaled nitric oxide was initiated 2 hours later at 20 parts per million as hypoxia persisted. Based on the severity of the emphysema and the unusual presenta...

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Pneumothorax and chylothorax in the neonatal period

Cited by 127 publications

References 13 publications

The use of fat-free human milk in infants with chylous pleural effusion

The use of fat-free human milk in infants with chylous pleural effusion

Chylothorax in Infants and Children

Pulmonary Interstitial Emphysema in a Full-Term Infant: Do We Know the Incidence?

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