Dietary treatment of congenital chylothorax with skimmed breast milk
Abstract Background Congenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experien...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | Italian Journal of Pediatrics |
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| Online Access: | https://doi.org/10.1186/s13052-021-01125-1 |
| _version_ | 1818719968290668544 |
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| author | Michaela Höck Alexander Höller Marlene Hammerl Karina Wechselberger Jakob Krösslhuber Ursula Kiechl-Kohlendorfer Sabine Scholl-Bürgi Daniela Karall |
| author_facet | Michaela Höck Alexander Höller Marlene Hammerl Karina Wechselberger Jakob Krösslhuber Ursula Kiechl-Kohlendorfer Sabine Scholl-Bürgi Daniela Karall |
| author_sort | Michaela Höck |
| collection | DOAJ |
| description | Abstract Background Congenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experience. Methods Neonates diagnosed with congenital chylothorax and treated at Innsbruck Medical University Hospital between 2013 and 2020 (n = 6, gestational age: 36 3/7, 32 5/7, 36 4/7, 35 0/7, 35 4/7, 37 3/7 weeks) were eligible for this report. The cornerstones of treatment for chylothorax conventionally consist of chest tube drainage (CTD), respiratory support, dietary restriction of long-chain triglycerides (LCT) or total parenteral nutrition (TPN). In further course the introduction of a medium-chain triglyceride (MCT)-based formula followed by an overlapping switch to a formula with low LCT and high MCT, containing the essential long-chain fatty acids (LCFA), is attempted. In three patients we used fat-modified (skimmed) breast milk to provide a high protein and low fat diet and to avoid the discontinuation of breast milk. Results The outcome of an early introduction of LCFA in the form of skimmed breast milk after resolution of chylothorax diverse. One patient had a favourable outcome, meaning no recurrence of pleural effusion, adequate weight gain and a content mother, while another patient had a relapse of pleural effusion after the administration of skimmed milk and was therefore transitioned back to Basic F® . The CC of patient 5 was difficult due to Noonan syndrome. Two weeks after the introduction of skimmed breast milk the mother wanted to stop to express breast milk, so nutrition was changed to Basic F®. Conclusion The first-line therapy of chylothorax is a combination of respiratory stabilization and dietary modification. The use of skimmed breast milk is advisable in CC and feasible by means of a simple milk defatting procedure. It offers benefits to mothers who wish to resume breast feeding after resolution of chylothorax and has proven positive effects, above all in preterm infants as optimal nutrition with protective components superior to formula feeding. However, the nutritional analysis of the skimmed milk and the correlation to a re-accumulation of pleural fluid remains a question to be answered. |
| first_indexed | 2024-12-17T20:15:22Z |
| format | Article |
| id | doaj.art-2a473f198c3f4029955d4690c40b987c |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-12-17T20:15:22Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-2a473f198c3f4029955d4690c40b987c2022-12-21T21:34:08ZengBMCItalian Journal of Pediatrics1824-72882021-08-014711710.1186/s13052-021-01125-1Dietary treatment of congenital chylothorax with skimmed breast milkMichaela Höck0Alexander Höller1Marlene Hammerl2Karina Wechselberger3Jakob Krösslhuber4Ursula Kiechl-Kohlendorfer5Sabine Scholl-Bürgi6Daniela Karall7Department of Paediatrics II, Neonatology, Medical University of InnsbruckService for Nutrition and Dietetics, Medical University of InnsbruckDepartment of Paediatrics II, Neonatology, Medical University of InnsbruckDepartment of Paediatrics II, Neonatology, Medical University of InnsbruckDepartment of Paediatrics I, Intensive Care Unit, Medical University of InnsbruckDepartment of Paediatrics II, Neonatology, Medical University of InnsbruckDepartment of Paediatrics I, Inherited Metabolic Disorders, Medical University of InnsbruckDepartment of Paediatrics I, Inherited Metabolic Disorders, Medical University of InnsbruckAbstract Background Congenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experience. Methods Neonates diagnosed with congenital chylothorax and treated at Innsbruck Medical University Hospital between 2013 and 2020 (n = 6, gestational age: 36 3/7, 32 5/7, 36 4/7, 35 0/7, 35 4/7, 37 3/7 weeks) were eligible for this report. The cornerstones of treatment for chylothorax conventionally consist of chest tube drainage (CTD), respiratory support, dietary restriction of long-chain triglycerides (LCT) or total parenteral nutrition (TPN). In further course the introduction of a medium-chain triglyceride (MCT)-based formula followed by an overlapping switch to a formula with low LCT and high MCT, containing the essential long-chain fatty acids (LCFA), is attempted. In three patients we used fat-modified (skimmed) breast milk to provide a high protein and low fat diet and to avoid the discontinuation of breast milk. Results The outcome of an early introduction of LCFA in the form of skimmed breast milk after resolution of chylothorax diverse. One patient had a favourable outcome, meaning no recurrence of pleural effusion, adequate weight gain and a content mother, while another patient had a relapse of pleural effusion after the administration of skimmed milk and was therefore transitioned back to Basic F® . The CC of patient 5 was difficult due to Noonan syndrome. Two weeks after the introduction of skimmed breast milk the mother wanted to stop to express breast milk, so nutrition was changed to Basic F®. Conclusion The first-line therapy of chylothorax is a combination of respiratory stabilization and dietary modification. The use of skimmed breast milk is advisable in CC and feasible by means of a simple milk defatting procedure. It offers benefits to mothers who wish to resume breast feeding after resolution of chylothorax and has proven positive effects, above all in preterm infants as optimal nutrition with protective components superior to formula feeding. However, the nutritional analysis of the skimmed milk and the correlation to a re-accumulation of pleural fluid remains a question to be answered.https://doi.org/10.1186/s13052-021-01125-1Congenital chylothoraxSkimmed breast milk |
| spellingShingle | Michaela Höck Alexander Höller Marlene Hammerl Karina Wechselberger Jakob Krösslhuber Ursula Kiechl-Kohlendorfer Sabine Scholl-Bürgi Daniela Karall Dietary treatment of congenital chylothorax with skimmed breast milk Italian Journal of Pediatrics Congenital chylothorax Skimmed breast milk |
| title | Dietary treatment of congenital chylothorax with skimmed breast milk |
| title_full | Dietary treatment of congenital chylothorax with skimmed breast milk |
| title_fullStr | Dietary treatment of congenital chylothorax with skimmed breast milk |
| title_full_unstemmed | Dietary treatment of congenital chylothorax with skimmed breast milk |
| title_short | Dietary treatment of congenital chylothorax with skimmed breast milk |
| title_sort | dietary treatment of congenital chylothorax with skimmed breast milk |
| topic | Congenital chylothorax Skimmed breast milk |
| url | https://doi.org/10.1186/s13052-021-01125-1 |
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