The use of high dose octreotide in management of neonatal chylothorax: Review

Abstract

BACKGROUND: Being a rare condition, the incidence of chylothorax among neonates is low, but the mortality rate is high. In a dire effort to reduce the risk of death, octreotide treatment is used to effectively treat acquired and congenital chylothorax. Octreotide is proven to effectively treat chylothorax in pre-term and full-term neonates. However, previous studies have not consistently demonstrated the optimal dose of octreotide or the best mode of administration. The objectives of this work were to review previous literature to determine the outcomes of administering high doses of octreotide compared to lower dose regimens in neonates with chylothorax and to determine best practices. METHODS: A literature search was performed using electronic databases using the key words neonates, chylothorax, and octreotide. RESULTS: Octreotide has been administrated in doses ranging from 0.5μg/kg/h to > 20μg/kg/h. Both low- and high-doses of octreotide are effective in resolving chylothorax with little to no side effects. When side effects were reported, neonates experienced side effects that are less significant in nature and scope. CONCLUSIONS: We recommend that the dose of octreotide in neonatal chylothorax can be titrated safely to a maximum of 20μg/kg/h without significant side effects.

Successful Management of Congenital Chylothorax in Neonates: A Series of 2 Cases

“…Doses range from 0.5 µg/kg/hour to 20 µg/kg/hour. 10 Though Cochrane review in 2010 did not support the use of octreotide in chylothorax, 11 a recent review by Bellini et al found octreotide to be effective in 47% cases, with equal response in both congenital and acquired cases. 12 Octreotide is usually considered in 3rd to 4th week in cases with persisting pleural effusion.…”

Diagnosis and treatment of lymphatic malformations: experience of the surgical department for newborns and infants

“…На сегодняшний день при развитии хилёзных выпотов, первичных или возникших в послеоперационном периоде, больному назначается полное парентеральное питание, терапия октреотидом, что способствует снижению продукции лимфы [41]. При отсутствии эффекта после 10-14 дней наблюдения за таким больным рассматривается вопрос о назначении иммуносупрессивной терапии сиролимусом [42].…”

“…По нашему мнению, при отсутствии положительной динамики в виде уменьшения объёма отделяемого по дренажу более 7-10 дней следует менять тактику лечения. В нашей выборке средние сроки получения положительного эффекта от введения октреотида сопоставимы с имеющимися данными (10-14 дней) [41].…”

Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China

“…Side effects and complications include hyperglycemia, abdominal distension, bloody stools, and pulmonary hypertension [20]. It has been suggested that high doses of octreotide can be used to treat refractory chylothorax, and the dose of octreotide can be safely titrated to a maximum of 20ug/kg/h with no significant side effects [21,22].…”