sanam mirzaie

Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Although octreotide has been used successfully to treat chylothorax, the exact mechanism of its action is uncertain and it is believed to reduce the lymphatic drainage through a direct action on splanchnic lymph flow. Case Report: We report two cases of congenital chylothorax who did not respond to supportive therapy (nutritional support and drainage) and where surgery service was avoided with the compassionate trial of octreotide. The first case was a 50-day-old infant with Noonan syndrome phenotype and another was an 18-day-old neonate with idiopathic congenital chylothorax. Treatment was associated with prompt respiratory improvement soon after starting the octerotide treatment and in the first and second cases the clinical symptoms resolved completely in 12 and 10 days after the onset of the treatment, respectively. Octreotide infusion was started at an initial dosage of 3 μg/kg/hour and increased daily by 1 μg/kg/hour to maximum 8 μg/kg/hour. The patients were well 2 months after the treatment. Octreotide infusion appears to have a good safety profile in newborns and remains a promising alternative to surgery for recalcitrant cases of chylothorax. Further studies are required to ascertain its true value in congenital chylothorax.