Quilotórax no feto e no recém-nascido – Orientação do tratamento

Chylothorax in the fetus and the neonate – Guidelines for treatment

 

Gustavo Rocha¹

Paula Guerra²

Inês Azevedo³

Hercília Guimarães⁴

 

 

Resumo

O quilotórax é o derrame pleural mais frequente no feto e no recém-nascido. O tratamento actual do quilotórax inclui várias e diferentes medidas terapêuticas pré e pós-natais.

Os autores apresentam, de forma prática e sumária, linhas de orientação para o tratamento do quilotórax no feto e no recém-nascido, incluindo a utilização das novas terapêuticas somatostatina e octreótido.

Palavras-chave: Quilotórax, recém-nascido, octreótido, somatostatina.

 

Abstract

Chylothorax is the most common pleural effusion in the fetus and the neonate. Actual treatment of chylothorax includes many different antenatal and postnatal therapeutical approaches.

The authors present practical and summarized guidelines for the treatment of chylothorax in the fetus and the neonate, including the new therapies somatostatin and octreotide.

Key-words: Chylothorax, newborn, octreotide, somatostatin.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliografia

1. Straaten HLM, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur J Pediatr 1993; 152:2.5.        [ Links ]

2. Bessone LN, Ferguson TB, Burford TH. Chylothorax. A collective review. Ann Thorac Surg 1971; 12:527-50.

3. Aerde JV, Campbell AN, Smyth JA, Lloyd D. Spontaneous chylothorax in newborns. Am J Dis Child 1984; 138:961-4.

4. Brodman RF, Zavelson TM, Schiebler GL. Treatment of congenital chylothorax. J Pediatr 1974; 85:516-7.

5. Yancy WS, Spock A. Spontaneous neonatal pleural effusion. J Pediatr Surg 1967; 2:313-9.

6. Chernick V, Reed MH. Pneumothorax and chylothorax in the neonatal period. J Pediatr 1970; 76:624.32.

7. Greenough A, Roberton NRC. Acute respiratory disease in the newborn. In: Janet M Rennie, NRC Roberton (eds.) Textbook of Neonatology. 3rd ed. London: Churchill Livingstone, 1999; 481-607.

8. Hansen TN, Corbet A, Ballard RA. Disorders of the Chest Wall, Pleural Cavity, and Diaphragm. In: Taeusch HW, Ballard AR, Gleason CA (eds.) Avery´s Diseases of the Newborn. 8 th ed. Philadelphia: Elsevier Saunders, 2005; 760-3.

9. Wasmuth-pietzuch A, Hansmann M, Bartman P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 2004; 93:220-4.

10. Philippe HJ, Paupe A, Dompeyre P, Jacquemard F, Lenclen R, Muller F, et al. Diagnostic antenatal et prise en charge du chylothorax congenital. Arch Fr Pediatr 1990; 47:737-40.

11. Hutchinson A, Drew J, Yu V. Nonimunologic hydrops fetalis: a review of 61 cases. Obstet Gynecol 1982; 59:347-52.

12. Koffler H, Papile F, Burnstein RL. Congenital chylothorax. Two cases associated with maternal polyhydramnios. Am J Dis Child 1978; 132:638.

13. Doyle J, Schmidt B, Blanchette V, Zipursky A. Hematology : In: Avery GB, Fletcher MA, MacDonald MG, eds. Neonatology – Pathophysiology & Management of the Newborn. 5 th ed. Philadelphia: Lippincott Williams & Wilkins, 1999; 1045-91.

14. Mussat P, Dommerges M, Parat S, Mandelbrot L, Gamarra E, Dumez Y, et al. Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis. Acta Paediatr 1995: 84;749-55.

15. Buttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest 1999; 116:682-7.

16. Hillerdal G. Chylothorax and pseudochylothorax. Eur  Respir J 1997; 10:1157-62.

17. Upadhyaya P. Pleural effusion. In: Puri P, editor: Newborn Surgery. 3rd ed. Oxford: Butterworts, 1996: 187-9.

18. Nicolaides KH, Blott M. Pleuroamniotic shunting for decompression of fetal pleural effusions. Obstet Gynecol 1988; 71:798-800.

19. Decano HG Jr. The treatment of chylothorax in children. Surg Gynecol Obstet 1965; 121:509-12.

20. Bond SJ, Guzzetta PC, Snyder ML, Randolph SG. Management of pediatric postoperative chylothorax. Ann Thorac Surg 1993; 56:469.72.

21. Costa F. Quilotórax. In: Maksoud JG, ed. Cirurgia Pediátrica. 2ª ed. Rio de Janeiro: Revinter, 2003; 624-30.

22. Rimensberger PC, Muller-Schenker B, Kalangos A, Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998; 66:253-4.

23. Kelly RF, Shumway SJ. Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 2000; 69:1944-5.

24. Ulibarri JI, Sanz Y, Fuentes C, Mancha A, Aramendia M, Sanchez S. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet 1990; 336:258.

25. Demos NJ, Kozel J, Scerbo JE. Somatostatin in the treatment of chylothorax. Chest 2001; 119:964-6.

26. Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendik PJ. Octreotide in the treatment of thoracic duct injuries. The American Surgeon 2000; 66:1165.7.

27. Cheung Y-F, Leung MP, Yip M-M. Octreotide for treatment of postoperative chylothorax. J Pediatr 2001; 139:157-9.

28. Roehr CC, Jung A, Proquitté H, Wauer RR. Systematic review: somatostatin or octreotide as treatment options of chylothorax in young children. Eur Resp J 2005; 26(supp 49):392s.

29. Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C. Etiology and management of pediatric chylothorax. J Pediatr 2000; 136:653-8.

30. Castillo RA, Devoe LD, Falls G, Holzman GB, Hadi HA, Fadel HE. Pleural effusions and pulmonary hypoplasia. Am J Obstet Gynecol 1987; 157:1252-5.

 

 

¹ Assistente Hospitalar, Serviço de Neonatologia, Departamento de Pediatria, Hospital de São João (HSJ)

² Assistente Hospitalar, Unidade de Nutrição, Departamento de Pediatria, HSJ

³ Assistente Hospitalar Graduada, Unidade de Pneumologia, Departamento de Pediatria, HSJ e Faculdade de Medicina do Porto (FMUP)

⁴ Directora do Serviço de Neonatologia, Departamento de Pediatria, HSJ e FMUP

 

Autor responsável: Gustavo Rocha

Serviço de Neonatologia / Departamento de Pediatria

Hospital de São João - Piso 2 - Alameda Prof. Hernâni Monteiro - 4200-319 Porto

Telefone: 225095816 - Fax: 225505919 - E-mail: gusrocha@oninet.pt

 

Recebido para publicação/received for publication: 06.05.24

Aceite para publicação/accepted for publication: 07.01.19