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Neonatal chylothorax : a retrospective study in a level III neonatal intensive care unit
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Introdução: O quilotórax neonatal é uma condição rara, potencialmente fatal, multifatorial, que se caracteriza pela acumulação de linfa no espaço pleural. Pode ser responsável por complicações nutricionais, metabólicas e imunológicas. O objetivo deste estudo é descrever a experiência da abordagem de recém-nascidos (RN), com o diagnóstico de quilotórax, internados numa Unidade de Cuidados Intensivos Neonatais (UCIN) terciária.
Métodos: Estudo observacional, descritivo, retrospetivo, com base na análise dos processos clínicos de RN com o diagnóstico de quilotórax, internados na UCIN do Hospital de Santa Maria, CHULN, EPE, de janeiro de 2012 a fevereiro de 2023.
Resultados: Foram incluídos oito doentes. A mediana da idade gestacional foi de 34 semanas e a mediana do peso foi 2350g. Metade dos casos foram congénitos, com diagnóstico pré-natal, 3 dos quais submetidos a intervenção pré-natal com colocação de shunt pleuro-amniótico. Metade foram iatrogénicos, secundários a trauma durante cirurgia torácica ou cervical. A maioria dos derrames pleurais eram unilaterais (n=5) e localizados à direita (n=3). Dois recém-nascidos apresentavam doença genética. Todos necessitaram de ventilação invasiva e sete de drenagem torácica. Todos fizeram nutrição parentérica e nutrição entérica com fórmula hipolipídica. Sete fizeram MCT oil. Nenhum respondeu totalmente à terapêutica conservadora pelo que todos foram tratados com octreótido, 6 dos quais com sucesso. Dois RN foram submetidos a pleurodese. Três necessitaram de terapêutica com imunoglobulina. Todos apresentaram complicações: 6 tiveram sépsis tardia, 2 tiveram pneumonia. A mediana do tempo de internamento foi de 35 dias. Registaram-se dois óbitos, um no contexto de sépsis com pneumonia e outro por hipoplasia pulmonar.
Conclusão: Nesta série de casos, metade dos doentes tinham diagnóstico pré-natal e metade foram iatrogénicos, refletindo a estreita colaboração da nossa unidade com o centro de diagnóstico pré-natal do Departamento de Obstetrícia e Ginecologia e com o Serviço de Cirurgia Pediátrica do CHULN, EPE. No que diz respeita à abordagem, não há diretrizes, nacionais ou internacionais, universalmente aceites ou baseadas na evidência, gerando controvérsia nalgumas das terapêuticas utilizadas. São imprescindíveis mais estudos, sobretudo multicêntricos, para avaliar a eficácia e os resultados a curto e longo prazo das várias estratégias utilizadas na prática clínica.
Introduction: Neonatal chylothorax is a rare, potentially fatal, multifactorial condition characterized by the accumulation of lymph in the pleural space. It can be responsible for nutritional, metabolic, and immunological complications. The aim of this study is to describe the management´s experience of newborns (NB) admitted with chylothorax to a tertiary Neonatal Intensive Care Unit (NICU). Methods: This is an observational, descriptive, retrospective study based on the analysis of clinical records of NB diagnosed with chylothorax, from January 2012 to February 2023, at the NICU of Hospital de Santa Maria, CHULN, EPE. Results: Eight patients were included. The median gestational age was 34 weeks, and the median weight was 2350g. Half of the cases were congenital, with pre-natal diagnosis, three of which underwent prenatal intervention with pleuro-amniotic shunt placement. The other half were iatrogenic, secondary to trauma during cervical or thoracic surgery. Most were unilateral effusions (n=5), and right-sided (n=3). Two newborns had genetic diseases. All required invasive ventilation, and seven underwent thoracic drainage. All received parenteral nutrition and enteral nutrition with a low-fat formula. Seven received MCT oil treatment. None responded completely to conservative therapy, so all were treated with octreotide, six successfully. Two NB were submitted to pleurodesis. Three required immunoglobulin therapy. All patients experienced complications: six had late-onset sepsis, and two had pneumonia. The median length of hospital stay was 35 days. Two deaths were recorded, one due to sepsis with pneumonia and the other due to pulmonary hypoplasia. Conclusion: In our case series, half of the patients had a prenatal diagnosis, and the other half were iatrogenic, reflecting the close collaboration of our unit with the prenatal diagnostic center of the Department of Obstetrics and Gynecology and the Pediatric Surgery Service of CHULN, EPE. Regarding its approach, there is a knowledge gap, without national or international evidence-based guidelines, causing controversy regarding some of the therapeutic interventions recurrently used. Further studies, especially multicenter studies, are essential to evaluate the effectiveness and short- and long-term outcomes of the various strategies used in clinical practice.
Introduction: Neonatal chylothorax is a rare, potentially fatal, multifactorial condition characterized by the accumulation of lymph in the pleural space. It can be responsible for nutritional, metabolic, and immunological complications. The aim of this study is to describe the management´s experience of newborns (NB) admitted with chylothorax to a tertiary Neonatal Intensive Care Unit (NICU). Methods: This is an observational, descriptive, retrospective study based on the analysis of clinical records of NB diagnosed with chylothorax, from January 2012 to February 2023, at the NICU of Hospital de Santa Maria, CHULN, EPE. Results: Eight patients were included. The median gestational age was 34 weeks, and the median weight was 2350g. Half of the cases were congenital, with pre-natal diagnosis, three of which underwent prenatal intervention with pleuro-amniotic shunt placement. The other half were iatrogenic, secondary to trauma during cervical or thoracic surgery. Most were unilateral effusions (n=5), and right-sided (n=3). Two newborns had genetic diseases. All required invasive ventilation, and seven underwent thoracic drainage. All received parenteral nutrition and enteral nutrition with a low-fat formula. Seven received MCT oil treatment. None responded completely to conservative therapy, so all were treated with octreotide, six successfully. Two NB were submitted to pleurodesis. Three required immunoglobulin therapy. All patients experienced complications: six had late-onset sepsis, and two had pneumonia. The median length of hospital stay was 35 days. Two deaths were recorded, one due to sepsis with pneumonia and the other due to pulmonary hypoplasia. Conclusion: In our case series, half of the patients had a prenatal diagnosis, and the other half were iatrogenic, reflecting the close collaboration of our unit with the prenatal diagnostic center of the Department of Obstetrics and Gynecology and the Pediatric Surgery Service of CHULN, EPE. Regarding its approach, there is a knowledge gap, without national or international evidence-based guidelines, causing controversy regarding some of the therapeutic interventions recurrently used. Further studies, especially multicenter studies, are essential to evaluate the effectiveness and short- and long-term outcomes of the various strategies used in clinical practice.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Quilotórax Recém-nascido Unidades de cuidados intensivos neonatais Pediatria