Sunrise Children's Hospital, Pediatrix Medical Group of Nevada, Las Vegas, Nevada.
Department of Pediatrics, University of Nevada, Las Vegas, Nevada.
Pediatrics. 2021 Jul;148(1). doi: 10.1542/peds.2020-049699. Epub 2021 Jun 29.
Chylothorax and chyloperitoneum are rare in infants and challenging to definitively diagnose by using current criteria extrapolated from the adult population. They can be of primary or secondary etiologies, including congenital lymphatic malformations and postoperatively, after cardiothoracic or abdominal surgery. Current first-line management consists of bowel rest, parenteral nutrition, and a modified diet of medium-chain triglycerides but can often take weeks to be effective. Off-label use of octreotide has been reported in numerous case studies for the management of chylous effusions. However, there are no definitive neonatal data available regarding dosing, safety, and efficacy; moreover, octreotide has a side effect profile that been linked to serious morbidities, such as pulmonary hypertension and necrotizing enterocolitis. Propranolol, commonly used for the treatment of infantile hemangiomas, is currently gaining interest as a novel therapy for chylous effusions. In this case series review, we describe the use of propranolol in 4 infants with presumed chylous effusions: 1 with congenital pleural effusions and 3 infants who developed postoperative chylothorax and/or chylous ascites. Clinical improvement was noted within a few days of initiating oral propranolol, and the maximum dose used in our cases was 6 mg/kg per day. In previous case reports, researchers describe the use of oral propranolol in infants with chylous effusions, with the dose used ranging from 0.5 to 4 mg/kg per day. However, this is the first case series in which researchers report its use exclusively in infants with chylothorax and chyloperitoneum. Although further research is needed to establish safety and efficacy, our experiences suggest that propranolol could be an acceptable treatment option for chylous effusions in infants.
乳糜胸和乳糜腹在婴儿中较为罕见，根据目前从成人人群中推断出的标准，难以明确诊断。它们可能是原发性或继发性的，包括先天性淋巴管畸形和心胸或腹部手术后。目前的一线治疗方法包括肠道休息、肠外营养和中链甘油三酯的改良饮食，但通常需要数周才能有效。奥曲肽的非适应证使用已在许多病例研究中报告用于治疗乳糜性渗出液。然而，关于剂量、安全性和疗效，尚无明确的新生儿数据；此外，奥曲肽的副作用与严重的并发症有关，如肺动脉高压和坏死性小肠结肠炎。普萘洛尔常用于治疗婴儿血管瘤，目前作为一种治疗乳糜性渗出液的新疗法引起了关注。在本病例系列回顾中，我们描述了在 4 名疑似乳糜性渗出液的婴儿中使用普萘洛尔的情况：1 名患有先天性胸腔积液，3 名婴儿在手术后出现乳糜性胸腔积液和/或乳糜性腹水。在开始口服普萘洛尔后的几天内，临床情况得到改善，我们病例中使用的最大剂量为每天 6 毫克/千克。在以前的病例报告中，研究人员描述了在乳糜性渗出液的婴儿中使用口服普萘洛尔的情况，剂量范围为每天 0.5 至 4 毫克/千克。然而，这是第一个专门报告其在乳糜胸和乳糜腹婴儿中使用的病例系列。尽管需要进一步研究以确定安全性和疗效，但我们的经验表明，普萘洛尔可能是婴儿乳糜性渗出液的一种可接受的治疗选择。
