Carr Benjamin D, Sampang Leilani, Church Joseph T, Mon Rodrigo A, Gadepalli Samir K, Attar Mohammad A, Perrone Erin E
Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Res. 2018 Nov;231:361-365. doi: 10.1016/j.jss.2018.05.082. Epub 2018 Jun 29.
Congenital chylothorax (CC) can have devastating consequences for neonates. We sought to determine the outcomes of cases treated at our institution and evaluate the role of fetal intervention.
With Institutional Review Board approval, patients treated at our institution 09/2006-04/2016 with CC were reviewed. History and outcomes were compared between patients undergoing fetal intervention (fetal group) and patients who did not (control group).
Twenty-three patients were identified. Mean gestational age at birth was 35 wk. Overall mortality was 30% (7 patients). Nineteen patients (83%) were prenatally diagnosed, and 10 patients (43%) underwent fetal intervention. Birth weight was significantly lower in the fetal group compared to the control group (median interquartile range [IQR]; 2.5 [2.3-3.0] versus 3.3 [2.6-3.7] kg, P = 0.02). Apgar scores were significantly higher in the fetal group than the control group at 1 and 5 min (median [IQR]; 6 [4-8] versus 1 [1-2], P = 0.005 and 8 [7-9] versus 2 [2-6], P = 0.008, respectively). For those patients with prenatal diagnosis of CC and hydrops fetalis, thrombosis and lymphopenia were both improved in the fetal group (thrombosis 0% versus 40%, P = 0.03; lymphocyte nadir [median {IQR}] 1.5 [0.6-2.9] versus 0.1 [0.05-0.2], P = 0.02). Duration of support with mechanical ventilation was significantly shorter in the fetal group (median [IQR]; 1 [0-40] versus 41 [29-75] d, P = 0.04).
Fetal intervention for CC is associated with improved Apgar scores and decreased ventilator days and complications in patients with hydrops fetalis. Fetuses with chylothorax, especially those with hydrops, should be referred to a fetal center for evaluation.
先天性乳糜胸（CC）可对新生儿产生严重后果。我们试图确定在我们机构接受治疗的病例的结局，并评估胎儿干预的作用。
经机构审查委员会批准，对2006年9月至2016年4月在我们机构接受CC治疗的患者进行了回顾。比较了接受胎儿干预的患者（胎儿组）和未接受胎儿干预的患者（对照组）的病史和结局。
共确定23例患者。出生时的平均胎龄为35周。总体死亡率为30%（7例患者）。19例患者（83%）在产前被诊断出，10例患者（43%）接受了胎儿干预。与对照组相比，胎儿组的出生体重显著更低（中位数四分位间距[IQR]；2.5[2.3 - 3.0]对3.3[2.6 - 3.7]kg，P = 0.02）。胎儿组在1分钟和5分钟时的阿氏评分显著高于对照组（中位数[IQR]；6[4 - 8]对1[1 - 2]，P = 0.005；8[7 - 9]对2[2 - 6]，P = 0.008）。对于那些产前诊断为CC和胎儿水肿的患者，胎儿组的血栓形成和淋巴细胞减少均得到改善（血栓形成0%对40%，P = 0.03；淋巴细胞最低点[中位数{IQR}]1.5[0.6 - 2.9]对0.1[0.05 - 0.2]，P = 0.02）。胎儿组机械通气支持的持续时间显著更短（中位数[IQR]；1[0 - 40]对41[29 - 75]天，P = 0.04）。
CC的胎儿干预与胎儿水肿患者阿氏评分的改善、呼吸机使用天数的减少以及并发症的减少相关。患有乳糜胸的胎儿，尤其是那些有水肿的胎儿，应转诊至胎儿中心进行评估。
