B. Carr1, L. Sampang1, J. Church1, R. Mon1, S. K. Gadepalli1, M. Attar1, E. E. Perrone1 1University Of Michigan,Ann Arbor, MI, USA
Introduction:
Congenital chylothorax, an accumulation of lymphatic fluid in the pleural space arising before birth, is a poorly understood phenomenon that can have devastating consequences for neonates. We sought to determine the outcomes of neonates treated at our institution with both operative and nonoperative measures. We also sought to determine the role of prenatal intervention in mitigating outcomes.
Methods:
Under an IRB-approved protocol (HUM00093133), patients treated at our institution 09/2006 – 04/ 2016 with congenital chylothorax were reviewed. Demographic information, intervention history, and perinatal outcomes were collected. All statistical analysis was performed using STATA v14 (StataCorp LLC, College Station, TX), and p<0.05 was considered significant.
Results:
A total of 26 patients were identified and 12 (46%) were female. Average gestational age at birth was 34.1±2.7 weeks, and average birth weight was 2815±614 grams. Overall mortality was 23% (6 patients). Twenty-two patients (85%) were prenatally diagnosed, and 14 patients (64%) underwent prenatal intervention for congenital chylothorax. In the intervention group, median gestational age was 33.5 weeks [IQR 31-35], with median birth weight 2479 grams [IQR 2170-3025]. In the no intervention group, median gestational age was 32 weeks [IQR 32.5-36] with median birth weight 2975 grams [IQR 2575-3383].
In the intervention group, median Apgar score at 1 minute was 4 [IQR 3-7], compared to 2 [IQR 1-2] in the no intervention group (p=0.006). Median Apgar score at 5 minutes in the intervention group was 8 [IQR 6-8], compared to 3.5 [IQR 2.5-5.5] in the no intervention group (p=0.003). All patients in the no intervention group required chest tubes, while 3 patients (21%) in the intervention group avoided chest tube placement. Mortality in the intervention group was 3 patients (21%), compared to 4 patients (50%) in the no intervention group (p=0.34). Of those patients who survived, median length of stay was 34 days [IQR 16-69] in the intervention group and 58.5 days [IQR 27-92] in the no intervention group (p=0.55), while median ventilator days were 3 [IQR 0-40] in the intervention group and 30.5 [IQR 10-58] in the no intervention group (p=0.47). There was no significant difference in need for chest compressions, need for surgery, or frequency of infections or pneumothoraces.
Conclusion:
Prenatal intervention for congenital chylothorax is associated with improved Apgar scores during resuscitation, but does not definitely improve overall outcomes. Our data support that clinicians must weigh the risks of prenatal intervention against the risks of difficult resuscitation in the first minutes of life.
