Neonatal Congenital Chylothorax Managed with Octreotide: A Review of Published Cases

Abstract

Background: Congenital chylothorax is a rare accumulation of lymphatic fluid in the pleural space and the most common cause
of neonatal pleural effusion, carrying substantial morbidity from pulmonary hypoplasia, hydrops, and secondary
immunodeficiency. Objective: To review published case reports/series, epidemiologic, pathophysiologic and management literature on octreotide (somatostatin-analogue) therapy for congenital chylothorax. Methods: Narrative review of individually verified case reports, case series, systematic reviews, a Cochrane review, and cohort/epidemiologic studies. Findings: Incidence estimates range from 1:5,800 to 1:24,000 live births. Across 11 published reports, octreotide (0.5-20 mcg/kg/h intravenous, or 10-70 mcg/kg/day subcutaneous) produced resolution in most treated neonates, including a 14-patient series with 85.7% survival and significantly reduced drainage (P=.002), though a Dutch series and the largest pooled analysis (753 cases) found inconsistent, dose-variable effects and no completed randomized trial. Conclusions: Octreotide is a reasonable adjunct to conservative management (drainage, medium-chain-triglyceride  feeding) in refractory congenital chylothorax, but evidence remains limited to case-level data, and dosing/duration are not standardized.