Congenital Chylothorax in Preterm Infants – A New Approach in Dietary Treatment with Skimmed Breast Milk

Abstract BackgroundCongenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experience.MethodsNeonates diagnosed with congenital chylothorax and treated at Innsbruck Medical University Hospital between 2013 and 2019 (n = 5, gestational age: 36 3/7, 32 5/7, 36 4/7, 35 0/7, 35 4/7) were eligible for this report. The cornerstones of treatment for chylothorax conventionally consist of chest tube drainage (CTD), respiratory support, dietary restriction of long-chain triglycerides (LCT) or total parenteral nutrition (TPN). In further course the introduction of a medium-chain triglyceride (MCT)-based formula followed by an overlapping switch to a formula with low LCT and high MCT, containing the essential long-chain fatty acids (LCFA), is attempted. As soon as possible, the change is made to breast milk feeding or breastfeeding. In two patients we used fat-modified (skimmed) breast milk to avoid discontinuation of breast milk feeding.ResultsThe early introduction of LCFA in the form of breast milk after resolution of chylothorax was associated with favourable outcome (no recurrence of pleural effusion and adequate weight gain).ConclusionThe first-line therapy of chylothorax is a combination of respiratory stabilization and dietary modification. The purpose of this report is to point out the feasibility of a fast change from LCT fat-free nutrition to full-fat nutrition once the chylothorax has dissolved, especially the early introduction of breast milk feeding / breastfeeding in infants with chylothorax.