Bellini Carlo, Cabano Rita, De Angelis Laura C, Bellini Tommaso, Calevo Maria G, Gandullia Paolo, Ramenghi Luca A
Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department of Mother and Child, Gaslini Children's Hospital, Genoa, Italy.
Epidemiology, Biostatistics and Committees Unit, Gaslini Children's Hospital, Genoa, Italy.
J Paediatr Child Health. 2018 Aug;54(8):840-847. doi: 10.1111/jpc.13889. Epub 2018 Mar 30.
Chylothorax is a rare but life-threatening condition in newborns. Octreotide, a somatostatin analogue, is widely used as a therapeutic option in neonates with congenital and acquired chylothorax, but its therapeutic role has not been clarified yet.
We performed a systematic review to assess the efficacy and safety of octreotide in the treatment of congenital and acquired chylothorax in newborns. Comprehensive research, updated till 31 October 2017, was performed by searching in PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases using the MeSH terms 'octreotide' and 'chylothorax'. Both term and preterm newborns with congenital or acquired chylothorax treated with octreotide within the 30th day of life were included. Octreotide treatment was considered effective if a progressive reduction/ceasing in drained chylous effusion occurred.
A total of 39 articles were included. Octreotide was effective in 47% of patients, with a slight but not significant difference between congenital (30/57; 53.3%) and acquired (9/27; 33.3%) chylothorax (P = 0.10). Marked variation in octreotide regimen was observed. The most common therapeutic scheme was intravenous infusion at a starting dose of 1 μg/kg/h, gradually increasing to 10 μg/kg/h according to the therapeutic response. Side effects were reported in 12 of 84 patients (14.3%). Only case reports were included in this review due to the lack of randomised controlled trials.
Octreotide is a relatively effective and safe treatment option in neonates with chylothorax, especially for the congenital forms.
乳糜胸在新生儿中虽罕见但危及生命。奥曲肽作为一种生长抑素类似物，被广泛用作先天性和后天性乳糜胸新生儿的治疗选择，但其治疗作用尚未明确。
我们进行了一项系统评价，以评估奥曲肽治疗新生儿先天性和后天性乳糜胸的疗效和安全性。通过在PubMed、MEDLINE、EMBASE和Cochrane对照试验中央注册库（CENTRAL）数据库中使用医学主题词“奥曲肽”和“乳糜胸”进行检索，开展了截至2017年10月31日的全面研究。纳入出生后30天内接受奥曲肽治疗的足月和早产先天性或后天性乳糜胸新生儿。如果引流的乳糜性胸腔积液逐渐减少/停止，则认为奥曲肽治疗有效。
共纳入39篇文章。奥曲肽在47%的患者中有效，先天性乳糜胸（30/57；53.3%）和后天性乳糜胸（9/27；33.3%）之间存在轻微但无显著差异（P = 0.10）。观察到奥曲肽治疗方案存在显著差异。最常见的治疗方案是静脉输注，起始剂量为1μg/kg/h，根据治疗反应逐渐增加至10μg/kg/h。84例患者中有12例（14.3%）报告了副作用。由于缺乏随机对照试验，本评价仅纳入了病例报告。
奥曲肽是治疗乳糜胸新生儿相对有效且安全的选择，尤其是对于先天性乳糜胸。
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