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

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.

Neonatal Chylothoraces: A 10-Year Experience in a Tertiary Neonatal Referral Centre

Background. Neonatal chylothorax is a rare condition, but has a high mortality. Study Objectives. To analyse the outcomes of a series of neonates with chylothorax and review the literature to determine best practice. Design. A case series review and a literature review using electronic databases including the key words neonates and chylothorax. Results. Six cases of neonatal chylothorax were identified during a ten-year period, two had congenital chylothoraces and four iatrogenic chylothoraces after thoracic surgery or chest instrumentation. The neonates were ventilated for a median of 30 (range 13–125) days with a median maximum daily pleural fluid output of 218 (range 86–310) ml/kg/day. All the neonates were given medium-chain triglyceride (MCT) feeds which stabilised pleural fluid output in four and reduced it in another. Octreotide was used in three neonates, but the dosage used had no significant effect on pleural output. Two neonates required surgical intervention. The literature review demonstrated MCT feeds can reduce or stabilise pleural fluid output, but highlighted variable use of octreotide and inconsistent dosing regimens and outcomes. No consensus regarding indications for surgical intervention was identified. Summary and Conclusion. Neonatal chylothorax is uncommon, but affected neonates require high healthcare utilisation.

Neonatal Morbidity and Mortality Pattern in the Special Care Baby Unit of BIRDEM

To identify the main causes of neonatal morbidity and mortality a retrospective study was carried out at the Special Care Baby Unit (SCABU) of the Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) for a period of 1 year from January to December 2005. A total of 361 neonates were included in this cohort. The ratio of male (200) and female (154) neonates was 1:0.7. Most of the babies (300) were born in this hospital. Major causes of morbidity were prematurity (60.7%), LBW ( 48.2%), jaundice (23.3%), severe perinatal asphyxia (10.8%), transient tachypnoea of newborn (10.8%), respiratory distress syndrome (6.4%) and sepsis (6.4%). Most deaths were associated with prematurity (71.1%), LBW (65.8%), intrauterine growth retardation (23.7%), respiratory distress syndrome (36.8%), severe perinatal asphyxia (18.4%) and sepsis/pneumonia (15.9%). Outcome of babies born in this hospital was better than those referred from other hospitals (p < 0.001). Ibrahim Med. Coll. J. 2007; 1(2): 1-4 Key Words: Neonates, morbidity, mortality, baby care. doi: 10.3329/imcj.v1i2.2896