Conservative management of chylothorax in infants using octreotide

Background: Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates and infants. Chylothorax causes respiratory and nutritional problems and has a significant mortality rate. Octreotide is a long-acting somatostatin analogue that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.Methods: Infants with spontaneous chylothorax over a period of 3 years were included in this study. A prospective, observational study was done. All patients were nil per oral initially. Oral feeds were resumed once the ICD output declined. Octreotide was given subcutaneously for all patients at a dose of 40 microgram/kg/day in 3 divided doses. Octreotide was stopped once the ICD output was less than 70-80 ml/day. ICD was inserted in all patients and removed once drainage was below 50 ml/day.Results: Five patients were diagnosed with chylothorax over a period of 3 years out of which 3 were male and 2 were females. 1 patient had right sided and 4 patients had left sided chylothorax. The average age of presentation was 5.6 months. Octreotide was administered for an average of 14.4 days (8-22 days). The average duration of ICD was 18.2 days. All patients recovered well and were discharged.Conclusions: Spontaneous chylothorax is rare in infants. Conservative management is usually successful. Early institution of oral feeds with octreotide preserves the child’s nutrition and avoids invasive procedures, such as reinsertion of chest tubes or surgery.

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Neonatal chylothorax

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192055 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1406

Author(s):

Tejinder P. Kaur ◽

Gursharan S. Narang ◽

Ashiana S.

Keyword(s):

Pleural Effusion ◽

Ductus Arteriosus ◽

Initial Management ◽

New Strategy ◽

Abnormal Accumulation ◽

Octreotide Treatment ◽

Fluid Production ◽

Congenital Chylothorax ◽

Long Acting ◽

Lymphatic Fluid

Chylothorax is the most common form of pleural effusion encountered in neonates. It is defined as abnormal accumulation of lymphatic fluid in the pleural space. It may be either congenital or an acquired condition. It causes respiratory and nutritional problems and significant mortality rate. Neonatal chylothorax respond to octreotide treatment. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. Initial management may include restriction of enteral feedings. Authors report a case of newborn baby born to gravida 2 mother at 32±2 weeks of gestation with left sided pleural effusion subsequently confirmed to be a congenital chylothorax with patent ductus arteriosus. USG guided tap was done, and milky fluid was aspirated.

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Congenital Chylothorax: Common and Uncommon Findings in an Infant with Chylous Effusions

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.38.6.357 ◽

2019 ◽

Vol 38 (6) ◽

pp. 357-364

Author(s):

Eileen DeWitt ◽

Michael Michalczyk

Keyword(s):

Disease Process ◽

Rare Condition ◽

Pleural Space ◽

Fetal Ultrasound ◽

Subcutaneous Edema ◽

Bilateral Chylothorax ◽

Abnormal Accumulation ◽

Congenital Chylothorax ◽

The Right ◽

Lymphatic Fluid

Congenital chylothorax is defined as an abnormal accumulation of lymphatic fluid in the pleural space. It is a rare condition in the neonate that causes significant respiratory, nutritional, and immunologic problems resulting in a high mortality rate. Presented here is a case of congenital bilateral chylothorax in a preterm infant. Fetal ultrasound at 33 weeks' gestation showed polyhydramnios, bilateral pleural effusions, ascites, and subcutaneous edema. Fetal pleuracentesis was done on the right side with 118 mL of fluid aspirated. This article addresses the management of this difficult disease process, complications, and implications for research of controversial therapies.

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Effect of the Long-Acting Somatostatin Analogue SMS 201–995 on Small-Intestinal Interdigestive Motility in the Dog

Scandinavian Journal of Gastroenterology ◽

10.3109/00365528809090758 ◽

1988 ◽

Vol 23 (7) ◽

pp. 769-774 ◽

Cited By ~ 11

Author(s):

T. L. Peeters ◽

K. W. Romanski ◽

J. Janssens ◽

G. Vantrappen

Keyword(s):

Somatostatin Analogue ◽

Small Intestinal ◽

Long Acting ◽

Interdigestive Motility

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Successful treatment with a long-acting somatostatin analogue(SMS201-995) in a patient with malignant carcinoid syndrome.

Japanese Journal of Medicine ◽

10.2169/internalmedicine1962.27.311 ◽

1988 ◽

Vol 27 (3) ◽

pp. 311-316 ◽

Cited By ~ 1

Author(s):

Masayuki TSUDA ◽

Shigehisa TAMAKI ◽

Eiichi IWASAKI ◽

Seikou MURASHIMA ◽

Katsumi DEGUCHI ◽

...

Keyword(s):

Successful Treatment ◽

Carcinoid Syndrome ◽

Somatostatin Analogue ◽

Malignant Carcinoid ◽

Malignant Carcinoid Syndrome ◽

Long Acting

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Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0031-1287792 ◽

2011 ◽

Vol 120 (02) ◽

pp. 68-72 ◽

Cited By ~ 10

Author(s):

A. Jawiarczyk ◽

M. Bolanowski ◽

J. Syrycka ◽

G. Bednarek-Tupikowska ◽

M. Kałużny ◽

...

Keyword(s):

Adrenal Gland ◽

Somatostatin Receptors ◽

Subcutaneous Administration ◽

Pancreatic Neuroendocrine Tumor ◽

Somatostatin Analogue ◽

Left Adrenal Gland ◽

Glucose Levels ◽

Long Acting ◽

The Right

AbstractWe are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

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Effect of Octreotide, a Long-Acting Somatostatin Analogue, on Plasma Amino Acid Uptake by the Pancreas

Pancreas ◽

10.1097/00006676-199111000-00008 ◽

1991 ◽

Vol 6 (6) ◽

pp. 668-672 ◽

Cited By ~ 10

Author(s):

L. Gullo ◽

R. Pezzilli ◽

Dvora Ancona ◽

A. Morselli Labate ◽

L. Barbara

Keyword(s):

Amino Acid ◽

Amino Acid Uptake ◽

Plasma Amino Acid ◽

Somatostatin Analogue ◽

Acid Uptake ◽

Long Acting

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Long-Acting Somatostatin Analogue Safety Monitoring Protocol for Outpatients With Neuroendocrine Tumors

Journal of the Advanced Practitioner in Oncology ◽

10.6004/jadpro.2019.10.7.2 ◽

2019 ◽

Vol 10 (7) ◽

Author(s):

Jordan Gabrielsen, PharmD ◽

Gianna Girone, PharmD ◽

Bonita Bennett, BSN ◽

Anna Jung, PharmD, BCPS

Keyword(s):

Neuroendocrine Tumors ◽

Safety Monitoring ◽

Somatostatin Analogue ◽

Monitoring Protocol ◽

Long Acting

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Short-term recovery of visual field loss in acromegaly during treatment with a long-acting somatostatin analogue

The American Journal of Medicine ◽

10.1016/0002-9343(89)90359-8 ◽

1989 ◽

Vol 86 (4) ◽

pp. 496-498 ◽

Cited By ~ 4

Author(s):

William E. Cobb ◽

Ivor M.D. Jackson

Keyword(s):

Visual Field ◽

Visual Field Loss ◽

Somatostatin Analogue ◽

Short Term ◽

Long Acting

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Somatostatin and gastrointestinal tract. Clinical experiences

Orvosi Hetilap ◽

10.1556/oh.2013.29721 ◽

2013 ◽

Vol 154 (39) ◽

pp. 1535-1540 ◽

Cited By ~ 3

Author(s):

László Herszényi ◽

Emese Mihály ◽

Zsolt Tulassay

Keyword(s):

Gastrointestinal Tract ◽

Gastrointestinal Hormones ◽

Gastrointestinal Diseases ◽

Somatostatin Analogues ◽

Therapeutic Modality ◽

Exocrine Function ◽

Somatostatin Analogue ◽

Clinical Experiences ◽

Pancreatic Fistulas ◽

Long Acting

The effect of somatostatin on the gastrointestinal tract is complex; it inhibits the release of gastrointestinal hormones, the exocrine function of the stomach, pancreas and bile, decreases motility and influences absorption as well. Based on these diverse effects there was an increased expectation towards the success of somatostatin therapy in various gastrointestinal disorders. The preconditions for somatostatin treatment was created by the development of long acting somatostatin analogues (octreotide, lanreotide). During the last twenty-five years large trials clarified the role of somatostatin analogues in the treatment of various gastrointestinal diseases. This study summarizes shortly these results. Somatostatin analogue treatment could be effective in various pathological conditions of the gastrointestinal tract, however, this therapeutic modality became a part of the clinical routine only in neuroendocrine tumours and adjuvant treatment of oesophageal variceal bleeding and pancreatic fistulas. Orv. Hetil., 2013, 154, 1535–1540.

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