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Trunk radiograph: Day 7 of life post PICC line insertion from the left upper limb demonstrating the tip in the right atrium (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Source publication
A premature female neonate with perforated necrotizing enterocolitis (NEC) required a laparotomy as well as a prolonged period of parental nutrition (PN) delivered via a left percutaneously inserted central catheter (PICC). Two weeks post PICC insertion, she developed left chylothorax with positioning of the PICC tip at the inlet of the thoracic du...
Context in source publication
Context 1
... (NEC). Laparotomy was not indicated until day 10 of life, this revealed a solitary perforation in the distal ileum with a localized meconium peritonitis. Following laparotomy and stoma formation, she was commenced on parental nutrition (PN) delivered via a peripheral inserted central catheter (PICC) in the left upper limb on day 7 of life (see Fig. 1) with the tip being in the right atrium. This was subsequently withdrawn to a satisfactory position in the midclavicular region. On day 21 of life, the patient developed pitting oedema over the left hemithorax and upper arm. Increased ventilatory requirements and worsening respiratory status occurred in conjunction with this. Chest ...
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Citations
... Previous published data has been different, with some authors describing a higher risk of chylothorax in patients with jugular or subclavian vein catheters [4], and other authors describing no link between PICCs in upper limbs and thrombosis after cardiac surgery [25]. There are some case reports, however, where chylothorax after PICC placements in upper limbs are described, especially in preterm infants [26,27]. The anatomic relationship of the thoracic duct and left subclavian vein could also play a role in a higher incidence of chylothorax in relation to PICC insertion by the left upper limb and its higher thrombosis rate. ...
The aim of this study was to analyze patients diagnosed with chylothorax after congenital heart disease surgery among a cohort of neonatal patients, comparing the evolution, complications, and prognosis after surgery of patients who were and were not diagnosed with chylothorax, and to analyze possible risk factors that may predict the appearance of chylothorax in this population. Retrospective and observational study included all neonates (less than 30 days since birth) who underwent congenital heart disease surgery in a level III neonatal intensive care department. We included infants born between January 2014 and December 2019. We excluded those infants who were born before 34 weeks of gestational age or whose birth weight was less than 1800 g. We also excluded catheter lab procedures and patent ductus arteriosus closure surgeries. Included patients were divided into two groups depending on whether they were diagnosed with chylothorax or not after surgery, and both groups were compared in terms of perinatal-obstetrical information, surgical data, and NICU course after surgery. We included 149 neonates with congenital heart disease surgery. Thirty-one patients (20.8%) developed chylothorax, and in ten patients (32.3%), it was considered large volume chylothorax. Regarding the evolution of these patients, 22 infants responded to general dietetic measures, a catheter procedure was performed in 9, and 5 of them finally required pleurodesis. Cardiopulmonary bypass, median sternotomy, and delayed sternal closure were the surgical variables associated with higher risks of chylothorax. Patients with chylothorax had a longer duration of inotropic support and mechanical ventilation and took longer to reach full enteral feeds. As complications, they had higher rates of cholestasis, catheter-related sepsis, and venous thrombosis. Although there were no differences in neonatal mortality, patients with chylothorax had a higher rate of mortality after the neonatal period. In a multiple linear regression model, thrombosis and cardiopulmonary bypass multiplied by 10.0 and 5.1, respectively, the risk of chylothorax and have an umbilical vein catheter decreases risk.Conclusion: We have found a high incidence of chylothorax after neonatal cardiac surgery, which prolongs the average stay and causes significant morbidity and mortality. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during the neonatal period.
What is Known:
• Acquired chylothorax in the neonatal period usually appears as a complication of congenital heart disease surgery, being the incidence quite variable among the different patient series (2.5–16.8%). The appearance of chylothorax as a complication of a cardiac surgery increases both mortality and morbidity in these patients, which makes it a quality improvement target in the postsurgical management of this population.
What is New:
•Most of the published studies include pediatric patients of all ages, from newborns to teenagers, and there is a lack of studies focusing on neonatal populations. The main strength of our study is that it reports, to the best of our knowledge, one of the largest series of neonatal patients receiving surgery for congenital heart disease in the first 30 days after birth. We have found a high incidence of chylothorax after cardiac surgery during the neonatal period compared to other studies. We suggested that chylothorax could be an underestimated complication of congenital heart disease surgery during this period of life.
