Somatostatin treatment of congenital chylothorax may induce transient hypothyroidism in newborns

Abstract

Aim: To describe a group of neonates with congenital, non‐traumatic chylothorax, one of whom developed transient hypothyroidism following treatment with somatostatin. Methods: The charts of seven infants with congenital chylothorax were reviewed in terms of their clinical presentation, the severity of their disease, the complications they presented and the duration of their hospitalization. Their pituitary–thyroid axis function was monitored in particular. Results: The seven infants, all preterm (32–34 wk), suffered from congenital chylothorax and hydrops fetalis diagnosed during the prenatal period. Four were treated by intrauterine drainage, and four had congenital malformations. Hospitalization lasted from 32 to 120 d. Three of the infants suffered from thrombocytopenia, three had chronic lung disease, and one suffered from Gram‐negative sepsis. The infant treated with somatostatin initially had normal thyroid function, but later developed primary transient hypothyroidism and was treated with L‐thyroxine. The thyroid screening tests for the infants who were not treated with somatostatin were all normal. Conclusions: Repeated doses of somatostatin were effective in reducing chylus production. Administering this treatment earlier should be considered in order to minimize known complications. The only potential side effect observed was primary transient hypothyroidism. Therefore, careful monitoring of the pituitary–thyroid axis is advised.

Congenital chylothorax: Associations and neonatal outcomes

“…A review of literature found a rate of diagnosis of 1 in 7000 to 1 in 10 000. [7][8][9] In our cohort the incidence was approximately 1 in 5800 live births. There is a suggestion that more infants are being diagnosed with this condition as compared with previously reported literature, mainly due to increase in complex cardiac surgeries in this population.…”

Congenital chylothorax: Clinical course and prognostic significance

“…Congenital chylothorax may occur in isolation or in association with certain genetic syndromes. It has been described in infants with Down syndrome, [10][11][12] Turner syndrome, 13 and other syndromes 6,14,15 and chromosomal aberrations. 6,[16][17][18] Association with primary congenital pulmonary lymphangiectasis, 19 H type fistula, 20 and bilateral agenesis of the superior vena cava with obstructive thoracic duct 21 was reported.…”

“…27 Congenital chylothorax complicated by hydrops fetalis has been described in other series. 5,6 All our cases with non immune hydrops fetalis had normal hematocrit and an intrauterine infection was ruled out. Their generalized edema probably resulted from protein depletion secondary to leakage into the pleural cavity and/or from elevation of intrathoracic pressure with subsequent obstruction of venous return.…”

“…Congenital chylothorax may be associated with abnormalities of the lymphatic system, chromosomal abnormalities, and congenital malformations. 5,6 Treatment includes prenatal thoracocentesis, 7 postnatal fluid drainage, respiratory, cardiovascular, hemodynamic support, and total parenteral nutrition, followed by feeding with enriched medium chain triglyceride (MCT) formula. 8 Only a few series of congenital chylothorax in the newborn are reported in the literature.…”

Congenital chylothorax in Opitz G/BBB syndrome

“…It may be primary or secondary. Primary chylothorax is due to lymphatic duct abnormalities and may occur in isolation or in association with clinical conditions (polyhydramnios, hydrops, intrathoracic mass) or certain genetic syndromes (i.e., Noonan, Turner and Fryns syndromes [Van Straaten et al, 1993], Down syndrome [Ho et al, 1989], inversion of chromosome 2 and Kabuki syndrome [Maayan‐Metzger et al, 2005]). Primary or congenital chylothorax is relatively uncommon: 1:10,000–15,000 live births.…”