Chandran Suresh, Agarwal Arpan, Llanora Genevieve Villablanca, Chua Mei Chien
Department of Neonatology, KK Women's and Children's Hospital, Singapore
Department of Neonatology, Duke NUS Medical School, Singapore.
BMJ Case Rep. 2020 Feb 11;13(2):e232062. doi: 10.1136/bcr-2019-232062.
Octreotide is a somatostatin analogue used for treating congenital chylothorax and congenital hyperinsulinism in infants. By increasing splanchnic arteriolar resistance and decreasing gastrointestinal blood flow, octreotide indirectly reduces lymphatic flow in chylous effusions.Splanchnic ischaemia following octreotide predisposes infants to necrotising enterocolitis (NEC). Although NEC occurrence in infants treated with octreotide for hyperinsulinaemic hypoglycaemia has been reported widely, its incidence in infants with chylothroax is low. We describe a case of congenital chylothorax in a preterm infant who had poor response to thoracentesis. Although octreotide initiation lead to resolution of chylothorax, he developed NEC. Cessation of octreotide and medical management resulted in rapid resolution of NEC. Since octreotide is generally used as the first-line treatment for chylous effusion, the risk of NEC should be considered, especially when the dosage is increased. Infants on octreotide should be closely observed for early signs and symptoms of NEC to avert surgical emergency.
奥曲肽是一种生长抑素类似物，用于治疗婴儿先天性乳糜胸和先天性高胰岛素血症。通过增加内脏小动脉阻力和减少胃肠道血流，奥曲肽可间接减少乳糜性胸腔积液中的淋巴液流动。奥曲肽导致的内脏缺血会使婴儿易患坏死性小肠结肠炎（NEC）。尽管广泛报道了使用奥曲肽治疗高胰岛素血症性低血糖的婴儿发生NEC的情况，但其在乳糜胸婴儿中的发生率较低。我们描述了1例对胸腔穿刺反应不佳的早产儿先天性乳糜胸病例。尽管开始使用奥曲肽后乳糜胸得到缓解，但他发生了NEC。停用奥曲肽并进行药物治疗后，NEC迅速得到缓解。由于奥曲肽通常被用作乳糜性胸腔积液的一线治疗药物，因此应考虑NEC的风险，尤其是在增加剂量时。应密切观察使用奥曲肽的婴儿是否出现NEC的早期体征和症状，以避免手术急症。
