Neonatal Med.  2024 Nov;31(3):73-79. 10.5385/nm.2024.31.3.73.

Successful Management of Refractory Chylothorax in Preterm Infants Using Hypertonic Glucose Pleurodesis

• Do YS
• Jung E
• Park SH
• Lee JM
• Lee HN
• Jeong J
• Kim SH
• Lee BS
• Kim KS
• Kim EAR

• KMID: 2561519
• DOI: http://doi.org/10.5385/nm.2024.31.3.73

Abstract

Neonatal chylothorax is a potentially fatal respiratory condition caused by a congenital or traumatic etiology. Conventional therapies, such as fasting, total parenteral nutrition, and intravenous octreotide, are generally successful in such cases; however, more invasive therapeutic measures, such as pleurodesis, should be considered in refractory cases. This case report presents two preterm infants with refractory chylothorax who were non-responsive to conventional treatment but were successfully managed using hypertonic glucose pleurodesis. The first case was that of a female infant born at 24⁺⁵ weeks of gestation (585 g) and diagnosed with postsurgical chylothorax at 68 days of life. Even after the initiation of fasting and intravenous octreotide administration, pleural drainage did not reduce. Therefore, the patient underwent three intermittent procedures of 50% glucose pleurodesis, which resulted in the resolution of the chylothorax and subsequent chest tube removal after 37 days. The second case was a female infant born at 34⁺⁶ weeks (3,040 g), who was diagnosed with congenital chylothorax immediately after birth. Fasting and intravenous octreotide failed to show any clinical effects; therefore, the patient underwent pleurodesis for 3 consecutive days. After the procedure, the amount of pleural drainage substantially decreased, and the chest tube was removed after 14 days. In both cases, a temporal relation between pleurodesis and chylothorax resolution was observed, suggesting that hypertonic glucose pleurodesis may be an effective and safe alternative for treating refractory chylothorax in preterm infants with minimal side effects. Further studies are needed to establish the optimal protocol for this procedure and to compare its efficacy with that of other pleurodesis agents.

Keyword

Chylothorax; Pleurodesis; Glucose solution, hypertonic

Figure

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  Figure 1. Subsequent supine chest X-ray findings (case 1): (A, B, C) on 68 days of life (DOL), diagnosis of chylothorax; (D) on 101 DOL, follow-up after first pleurodesis; (E) on 109 DOL, recurrent chylothorax; and (F) on 137 DOL, the day of chest tube removal.

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  Figure 2. (A, B) The graphic trend of daily chest tube drainage (mL/day) and octreotide infusion rate from the commencement of intravenous octreotide until chest tube removal, respectively. Abbreviations: NPO, nil per os; DOL, days of life; Lt, left; Rt, right.

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  Figure 3. Subsequent supine chest X-ray findings (case 2): (A, B) postnatal chest ultrasound findings of bilateral pleural effusion, on the day of birth; (C, D) on 0 day of life (DOL), right after left chest tube insertion; (E) on 28 DOL after chemical pleurodesis; and (F) on 42 DOL, the day of discharge.

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