Management of Congenital Chylothorax in Intensive Neonatal Care Unit in Sfax, Tunisia: A Case Series and Review of the Literature

Abstract

Background: Congenital Chylothorax (CC) is a rare condition, which is defined as an accumulation of the chyle in the pleural cavity;moreover, it is associated with significant morbidities, including respiratory distress, malnutrition, immunodeficiency, and infections. Case Report: The diagnosis of chylothorax was made upon count cell analysis of the pleural fluid with ≥80% lymphocytesdetected before birth or within 28 days after birth. In this study, we presented five cases of CC infants. They were dischargedfrom our tertiary center at Hedi Chaker Hospital, Sfax, Tunisia, from January 2010 to December 2018. There were three malesand two females. Prenatal diagnosis was made in four cases. There were four full-term newborns and one near-term of 36weeks. Pleural effusion was on the right side in three cases, on the left side in one case, and bilateral in one case. Four casesrequired mechanical ventilation. Somatostatin was indicated in one case. The treatment was successful in four cases. One casepresented a dysmorphic syndrome and died of pneumothorax.Conclusion: The treatment of CC is based on conservative management. Somatostatin or its analog octreotide is considered anadjunctive treatment of CC. However, the refractory cases are treated with chemical pleurodesis or surgical treatment. Wepropose an algorithm for the treatment of CC.

Keywords

• algorithm
• congenital chylothorax
• octreotide
• pleurodesis