Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Prenatal factors associated with neonatal survival of infants with congenital chylothorax

Journal of Perinatology volume 38, pages 31–34 (2018)Cite this article

Subjects

Abstract

Objectives:

Congenital chylothorax is a rare disease and prognostic factors are key element in properly informing parents. This study aimed at determining the prenatal factors associated with neonatal survival in a cohort of liveborn infants with congenital chylothorax.

Study design:

Observational monocentric cohort study including all liveborn neonates consecutively admitted for congenital chylothorax.

Results:

Neonatal mortality was 32% (16/50). Prematurity (or birth weight), persistence of hydrops at birth and the absence of thoracoamniotic shunt procedure were significantly associated with mortality, whereas prenatal diagnosis of pleural effusion, side of pleural effusion, hydrops fetalis and amniodrainage were not. In case of prenatal diagnosis of hydrops fetalis, the reversal in utero of hydrops fetalis was significantly associated with survival (P=0.001). In case of thoracoamniotic shunting, the interval between thoracoamniotic shunting intervention and delivery was significantly longer for patients who survived (P=0.03).

Conclusions:

Thoracoamniotic shunting and reversal of hydrops significantly improves survival, whereas prematurity worsened outcome of liveborn infants with congenital chylothorax. Our data also suggest that the interval between thoracoamniotic shunting and birth appears to be crucial; the longer the interval, the more likely is the reversal of antenatal hydrops and neonatal survival.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Attar MA, Donn SM . Congenital chylothorax. Semin Fetal Neonat Med 2017; 22 (4): 234–239.

    Article  Google Scholar 

  2. Bialkowski A, Poets CF, Franz AR . Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonat Ed 2015; 100 (2): F169–F172.

    Article  Google Scholar 

  3. Tutor JD . Chylothorax in infants and children. Pediatrics 2014; 133 (4): 722–733.

    Article  Google Scholar 

  4. Das A, Shah PS . Octreotide for the treatment of chylothorax in neonates. The Cochrane Database Syst Rev 2010; (9): CD006388. (doi: 10.1002/14651858.CD006388.pub2).

  5. Deurloo KL, Devlieger R, Lopriore E, Klumper FJ, Oepkes D . Isolated fetal hydrothorax with hydrops: a systematic review of prenatal treatment options. Prenat Diagn 2007; 27 (10): 893–899.

    Article  CAS  Google Scholar 

  6. Caserio S, Gallego C, Martin P, Moral MT, Pallas CR, Galindo A . Congenital chylothorax: from foetal life to adolescence. Acta Paediatr 2010; 99 (10): 1571–1577.

    Article  CAS  Google Scholar 

  7. Church JT, Antunez AG, Dean A, Matusko N, Deatrick KB, Attar MA et al. Evidence-based management of chylothorax in infants. J Pediatr Surg 2017; 52 (6): 907–912.

    Article  Google Scholar 

  8. Salomon LJ, Duyme M, Crequat J, Brodaty G, Talmant C, Fries N et al. French fetal biometry: reference equations and comparison with other charts. Ultrasound Obstet Gynecol 2006; 28 (2): 193–198.

    Article  CAS  Google Scholar 

  9. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273 (5): 413–418.

    Article  Google Scholar 

  10. Norton ME, Chauhan SP, Dashe JS . Society for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis. Am J Obstet Gynecol 2015; 212 (2): 127–139.

    Article  Google Scholar 

  11. Picone O, Benachi A, Mandelbrot L, Ruano R, Dumez Y, Dommergues M . Thoracoamniotic shunting for fetal pleural effusions with hydrops. Am J Obstet Gynecol 2004; 191 (6): 2047–2050.

    Article  Google Scholar 

  12. Moise KJ Jr . Toward consistent terminology: assessment and reporting of amniotic fluid volume. Semin Perinatol 2013; 37 (5): 370–374.

    Article  Google Scholar 

  13. Yinon Y, Grisaru-Granovsky S, Chaddha V, Windrim R, Seaward PG, Kelly EN et al. Perinatal outcome following fetal chest shunt insertion for pleural effusion. Ultrasound Obstet Gynecol 2010; 36 (1): 58–64.

    Article  CAS  Google Scholar 

  14. Abrams ME, Meredith KS, Kinnard P, Clark RH . Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 2007; 120 (1): 84–89.

    Article  Google Scholar 

  15. Diomande D, Husseini K, Meau-Petit V, Dupont C, Picone O, Boileau P . Early-onset pneumothorax indicates poor outcome in newborns with congenital idiopathic chylothorax. Arch Dis Child Fetal Neonat Ed 2008; 93 (4): F327–F328.

    Article  CAS  Google Scholar 

  16. Huang HR, Tsay PK, Chiang MC, Lien R, Chou YH . Prognostic factors and clinical features in liveborn neonates with hydrops fetalis. Am J Perinatol 2007; 24 (1): 33–38.

    Article  Google Scholar 

  17. Pellegrinelli JM, Kohler A, Kohler M, Weingertner AS, Favre R . Prenatal management and thoracoamniotic shunting in primary fetal pleural effusions: a single centre experience. Prenat Diagn 2012; 32 (5): 467–471.

    Article  CAS  Google Scholar 

  18. Knox EM, Kilby MD, Martin WL, Khan KS . In-utero pulmonary drainage in the management of primary hydrothorax and congenital cystic lung lesion: a systematic review. Ultrasound Obstetr Gynecol 2006; 28 (5): 726–734.

    Article  CAS  Google Scholar 

  19. Tsukimori K, Nakanami N, Fukushima K, Yoshimura T, Hikino S, Nakano H . Pleural fluid/serum immunoglobulin ratio is a diagnostic marker for congenital chylothorax in utero. J Perinat Med 2006; 34 (4): 313–317.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the ‘Association pour la Recherche et la Formation En Neonatologie (ARFEN)’, which provides technical assistance.

Author contributions

MD, AG and AL drafted the manuscript. They designed and participated in the study. They had access to all of the primary data and performed the statistical analyses. They participated in the review, revision and approval of the final manuscript. FL, JS, LSB, MN, ZA, NKD, EK, JFM and YV participated to the study and had access to all of the primary data. They critically revised the manuscript and provided significant scientific input. They participated in the review, revision and approval of the final manuscript.

Author information

Author notes

  1. M Dorsi and A Giuseppi: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France

    M Dorsi, A Giuseppi, M Nicloux, Z Assaf, E Kermorvant-Duchemin, J-F Magny & A Lapillonne

  2. Department of Pediatric Intensive Care, APHP Necker Hospital, Paris, France

    F Lesage

  3. Paris Descartes University (EA 7328), Sorbonne Paris Cite, France

    J Stirnemann, L De Saint Blanquat, N Khen Dunlop, E Kermorvant-Duchemin, J-F Magny, Y Ville & A Lapillonne

  4. Department of Obstetrics, APHP Necker Hospital, Paris, France

    J Stirnemann & Y Ville

  5. Department of Pediatric Surgery, APHP Necker Hospital, Paris, France

    N Khen Dunlop

Authors
  1. M Dorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Giuseppi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F Lesage
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Stirnemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L De Saint Blanquat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Nicloux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Z Assaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N Khen Dunlop
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E Kermorvant-Duchemin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J-F Magny
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Y Ville
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A Lapillonne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Lapillonne.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Perinatology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dorsi, M., Giuseppi, A., Lesage, F. et al. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol 38, 31–34 (2018). https://doi.org/10.1038/jp.2017.150

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2017.150

This article is cited by

Search

Advanced search

Quick links