G402(P) The management of congenital pleural effusions. (27th April 2016)

• Record Type: Journal Article
• Authors: Shillitoe, BMJ; Berrington, JE; Cafferky, N; Athiraman, N
• Is Part Of: Archives of disease in childhood. Volume 101(2016)Supplement 1
• Page Start: A235
• Page End: A236
• Publication Date: 2016-04-27
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2016-310863.392
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background and aims: There is scant literature describing the evolution and management of congenital pleural effusions with most focus on Octreotide. 1 We present 15-year case series in a tertiary centre to add to this literature and to contribute to the development of a clinical guideline. Methods: Cases were identified from unit and regional abnormality survey databases. We included effusions detected antenatally or developing within 28 days between January 2000 and May 2015. We excluded intra-uterine deaths, still-births, termination of pregnancies and those which resolved antenatally. Data were available for 21/23 eligible cases. Results: 43% died, mainly from early respiratory failure (median age at death 1 day) but later deaths occurred up to 57 days. The 83% of babies whose drainage resolved without octreotide or MCT formula, did so at a median age of 4 Days (range <1–9 days). 2 babies with chylothorax had outputs that did not spontaneously resolve; 1 was given octreotide at day 10 and both started MCT formula, at 17 and 4 days respectively. Conclusions: 83% of survivors had drainage that was self-limiting (lasting 9 days or less, drain outputs < 100 mls/Kg/Day). A second distinct group of confirmed chylothorax had outputs up to 200 mls/Kg/Day, lasting up to 3 weeks. Given this separation between groups we now recommend Octreotide/MCT if drainage persists >9 days. References: Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. In: Shah PS, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd 2010. doi:10.1002/14651858. CD006388.pub2 Al-Tawil K, Ahmed G, Al-Hathal M, et al . CONGENITAL CHYLOTHORAX. Amer J Perinatol 2000; 17:121–6. doi:10.1055/s-2000-9281 Brissaud O, Desfrere L, Mohsen R, et al . Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). Arch Dis Child – Fetal Neonatal Ed 2003; 88 :F531–3. doi:10.1136/fn.88.6. F531