Chylothorax in infants and children in the United Kingdom

Abstract

This study was carried out following observation from health professionals in the paediatric intensive care community that the incidence of chylothorax development in infants and children in the United Kingdom was unknown. Furthermore, treatment strategies were based on limited international evidence from single centre, small scale, retrospective cohort studies or case series. The aim of this study was therefore to determine the size and extent of the problem by establishing the current incidence, patient profile, management strategies and discharge destination or outcome of infants and children who developed a chylothorax in the UK. Infants and children ? 24 weeks gestation to ? 16 years, who developed a chylothorax in the UK were prospectively reported through the British Paediatric Surveillance Unit (BPSU). Clinicians completed a questionnaire on the presentation, diagnosis, management and discharge destination or outcome of these children. Three further additional data sources were accessed to confirm this data. A total of 219 questionnaires were returned with 173 cases meeting the eligibility criteria for inclusion. The incidence in children in the UK was 1.4 in 100,000 (0.0014%), in infants ? 12 months 16 in 100,000 (0.016%) and for those developing a chylothorax following cardiac surgery it was 3.1% (3,100 in 100,000). The majority of chylothoraces were reported following cardiac surgery (65.3%). Chylothorax was most frequently confirmed by laboratory verification of triglyceride content of the pleural fluid ? 1.1 mmol/litre (66%). Although a variety of management strategies were employed, treatment with an intercostal pleural catheter (86.5%) and a Medium Chain Triglyceride (MCT) diet (89%) were most commonly reported. The majority of the children had a prolonged hospital stay (median 29.5 days), with a reported mortality of 12.5%. The results of this study indicate that the development of a chylothorax in infants and children in the UK is not common; although incidence is higher in children having cardiac surgery. The duration of hospital stay is lengthy and therefore the impact on the child, family and hospital resources are significant. Common management strategies exist, but the variation in these and the lack of an outcome based rationale suggest national guidance is required.

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ORCID for B. Walsh: orcid.org/0000-0003-1008-0545

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