We report the use of
somatostatin in two preterm neonates with
chylothorax and discuss those cases in the light of current literature on the treatment of
chylothorax in infants born preterm.
Chylothorax, a severe complication in thorax surgery, is also a symptom of different diseases and may even occur spontaneously. Treatment is difficult, especially in preterm neonates with co-morbidities. The standard therapeutic strategy with non-invasive procedures (e.g. enteral diet free of long chain
triglycerides or
parenteral nutrition) is not always effective. Surgical interventions, like
pleurodesis,
ligation of the ductus thoracicus, or pleuroperitoneal shunt may be of considerable risk in preterm infants and must be carefully evaluated.
Somatostatin is a new non-invasive therapeutic option for the treatment of
chylothorax in adults and older pediatric patients. Case reports demonstrate the effectiveness of the
somatostatin treatment, mostly in adult patients and in adolescents. There are only few case reports describing the use of
somatostatin in preterm neonates. One VLBW (very low birth weight) and one hypotrophic ELBW (extremely low birth weight) neonate (gestational ages of 30+3/7, and 25+2/7 weeks;
birth weights of 1270g, and 450g respectively) were treated for
chylothorax with continuous infusion of
somatostatin in addition to the dietary treatment. The
chylothorax disappeared after start of
somatostatin. No major side-effects of the
somatostatin treatment were observed. As reported in other published pediatric cases,
somatostatin seems to be a therapeutic option for the treatment of
chylothorax in preterm neonates. In review of the literature we identified another eleven case reports on the treatment of persistent
chylothorax with
somatostatin or
octreotide in preterm neonates. Further observations are needed before
somatostatin can be recommended as a standard first-line treatment procedure for
chylothorax in infants.