Bristol Royal Hospital for Children, Bristol, UK University of Southampton, Southampton, UK.
University of Southampton, Southampton, UK.
Arch Dis Child. 2014 Aug;99(8):724-30. doi: 10.1136/archdischild-2013-304364. Epub 2014 Apr 4.
To describe the incidence, patient profile, management strategies and outcome for infants and children who developed a chylothorax in the UK.
A prospective study of infants and children ≥24 weeks' gestation - ≤16 years, who developed a chylothorax in the UK and were reported through the British Paediatric Surveillance Unit (BPSU). Clinicians completed a questionnaire on the presentation, diagnosis, management and outcome of these children. Three further data sources were accessed to confirm these data.
The incidence in children in the UK was 0.0014% (1.4 per 100,000) and 3.2% (3200 per 100,000) for those developing a chylothorax following a cardiac surgical procedure. The incidence was highest in infants ≤12 months at 16 per 100,000 (0.016%). A total of 219 questionnaires were returned with 172 cases meeting the eligibility criteria. Development of a chylothorax was most commonly associated with cardiac surgical procedure (65.1%) and was most frequently confirmed by laboratory verification of triglyceride content of the pleural fluid ≥1.1 mmol/L (66%). Although a variety of management strategies were employed, treatment with an intercostal pleural catheter (86.5%) and a medium chain triglyceride (MCT) diet (89%) was most commonly reported. The majority of the children had a prolonged hospital stay with a reported mortality of 12.2%.
Development of a chylothorax in infants and children in the UK was not common. The primary association was with a cardiac surgical procedure. The child's hospital stay was lengthy and therefore the impact on the child, family and hospital resources were significant. Common management strategies existed but national guidance is required to optimise practice. This study allows for better information relating to this serious complication to be given to patients and families and provides the basis for future research and practice development.
描述英国发生乳糜胸的婴儿和儿童的发病率、患者特征、管理策略和结局。
对英国≥24 周胎龄-≤16 岁发生乳糜胸的婴儿和儿童进行前瞻性研究，并通过英国儿科监测单位（BPSU）报告。临床医生填写了一份问卷，内容包括这些儿童的临床表现、诊断、治疗和结局。还通过另外三个数据来源确认了这些数据。
英国儿童乳糜胸的发病率为 0.0014%（每 10 万人中有 1.4 例），心脏手术后发生乳糜胸的发病率为 3.2%（每 10 万人中有 3200 例）。发病率在≤12 个月的婴儿中最高，为每 10 万人 16 例（0.016%）。共收回 219 份问卷，其中 172 例符合入选标准。乳糜胸的发生最常与心脏手术有关（65.1%），最常通过实验室验证胸腔液中甘油三酯含量≥1.1 mmol/L（66%）来确诊。尽管采用了多种治疗策略，但最常报告的是肋间胸腔引流管（86.5%）和中链甘油三酯（MCT）饮食（89%）治疗。大多数儿童住院时间延长，报告死亡率为 12.2%。
英国婴儿和儿童乳糜胸的发生并不常见。主要与心脏手术有关。患儿住院时间长，因此对患儿、家庭和医院资源的影响都很大。存在常见的治疗策略，但需要制定国家指南以优化治疗。本研究为向患者和家属提供与这种严重并发症相关的更好信息提供了依据，并为未来的研究和实践发展奠定了基础。
