Kankananarachchi I, Priyankara K K S, Lakman K K K, Withanaarachchi K, Gunathilaka P K G
Department of Paediatrics, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka.
Paediatric Pulmonology Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka.
Case Rep Pediatr. 2021 Aug 7;2021:6634326. doi: 10.1155/2021/6634326. eCollection 2021.
Congenital chylothorax (CC) is one of the most common causes of pleural effusions in neonates. Associated ipsilateral pulmonary aplasia in CC results in neonatal respiratory distress. Here, we report 2 cases of CC who were managed in the Teaching Hospital Karapitiya, Sri Lanka, between 2017 and 2019. Both babies were males who presented with respiratory distress within a few hours of birth. Their antenatal ultrasound scans failed to detect CC. Chest radiographs showed left-sided pleural effusions. Pleural fluid was milky yellowish suggestive of chylothorax, and the analysis revealed elevated triglycerides, high lymphocyte counts, and low cholesterol levels compatible with CC. They were managed in the neonatal intensive care unit and kept nil by mouth for initial 48 hours. Intravenous octeotride infusion was started on day one and was continued for 7 and 10 days, respectively. The maximum dose of octeotride was 2 g/kg/hour. Both babies needed intercostal tube placement for 5 and 6 days, respectively. None of them required invasive ventilation. They were started on a medium-chain fatty acid formula, which was continued for about one week. Both babies were commenced on breast milk by day 7 of life and continued with exclusive breastfeeding. Within two weeks, they were discharged home and followed up in the paediatric respiratory clinic for another year. None of them was found to have long-term respiratory complications during the follow-up.
先天性乳糜胸（CC）是新生儿胸腔积液最常见的病因之一。CC合并同侧肺发育不全可导致新生儿呼吸窘迫。在此，我们报告2017年至2019年间在斯里兰卡卡拉皮蒂亚教学医院诊治的2例CC患儿。两名婴儿均为男性，出生后数小时内出现呼吸窘迫。他们的产前超声检查未能检测出CC。胸部X线片显示左侧胸腔积液。胸腔积液呈乳黄色，提示乳糜胸，分析显示甘油三酯升高、淋巴细胞计数高、胆固醇水平低，符合CC表现。他们在新生儿重症监护病房接受治疗，最初48小时禁食。第1天开始静脉输注奥曲肽，分别持续7天和10天。奥曲肽的最大剂量为2μg/kg/小时。两名婴儿分别需要放置肋间引流管5天和6天。他们均无需有创通气。开始给予中链脂肪酸配方奶，持续约一周。两名婴儿均在出生后第7天开始母乳喂养，并持续纯母乳喂养。两周内，他们出院回家，并在儿科呼吸门诊随访了一年。随访期间未发现他们有长期呼吸并发症。
