| Abstract | Cilj: Hilotoraks komplikacija je koja se javlja u bolesnika s prirođenom dijafragmalnom hernijom (PDH). Cilj ovog rada istražiti je incidenciju i ishod hilotoraksa, opisati i usporediti karakteristike bolesnika s i bez hilotoraksa te ispitati postoje li čimbenici rizika za nastanak hilotoraksa u bolesnika s PDH.
Metode: U ovo retrospektivno kohortno istraživanje uključeni su bolesnici s PDH koji su se liječili u Zavodu za neonatologiju i neonatalnu intenzivnu medicinu Klinike za pedijatriju KBC-a Zagrebu u razdoblju od 1997. godine do 2022. godine. U bolesnika s hilotoraksom opisana su obilježja torakalne drenaže i modaliteti liječenja, a bolesnici s i bez hilotoraksa uspoređeni su prema demografskim i perinatalnim podatcima, pridruženim anomalijama,morfološkim karakteristikama dijafragmalnog defekta, liječenju, ishodu te broju i udjelu limfocita.
Rezultati: Analiziran je 81 bolesnik s PDH, a 18 (22%) bolesnika imalo je hilotoraks. Svi su bolesnici liječeni konzervativno. U svih je bolesnika primijenjena torakalna drenaža. U 15 (83%) bolesnika obustavljen je enteralni unos, a enteralna prehrana započeta je mliječnim pripravkom s visokim udjelom srednjelančanih masnih kiselina (Monogen) u 10 (56%) bolesnika. Umrla su 2 (11,1%) bolesnika s hilotoraksom. Nije pronađena razlika između bolesnika s i bez hilotoraksa u demografskim i perinatalnim karakteristikama, morfološkim karakteristikama dijafragmalnog defekta, pridruženim anomalijama, načinu liječenja, vrsti operacije te smrtnosti. U bolesnika s hilotoraksom PDH se prenatalno otkrivala ranije (p=0,004). Bolesnici s hilotoraksom značajno su dulje mehanički ventilirani (p<0,001) i bili su dulje hospitalizirani (p<0,001). Bolesnici s hilotoraksom imali su manji najmanji apsolutni broj (p=0,003) i udio (p<0,001) limfocita u prvih 30 dana života te manji prosječni tjedni apsolutni broj limfocita u drugom, trećem i četvrtom tjednu života (p<0,001). Unatoč manjem broju limfocita, bolesnici s hilotoraksom nisu imali veću učestalost sepse.
Zaključak: Hilotoraks u bolesnika s PDH povećava morbiditet, ali ne utječe na smrtnost. Hilotoraks se povlači konzervativnim liječenjem i u većini slučajeva nema potrebe za kirurškim liječenjem. U ovom istraživanju nisu pronađeni rizični čimbenici za nastanak hilotoraksa u bolesnika s PDH. Limfopenija u bolesnika s PDH mogući je laboratorijski marker koji upućuje na razvoj hilotoraksa, međutim, potrebna su dodatna istraživanja kako bi se to potvrdilo. |
| Abstract (english) | Purpose: Chylothorax is a known complication that occurs in patients with congenital diaphragmatic hernia (CDH). Aim of this paper is to investigate the incidence and outcomes of chylothorax, describe and compare the characteristics of patients with and without chylothorax, and to examine whether there are risk factors for the occurrence of chylothorax.
Methods: This retrospective cohort study included patients with CDH who were treated from 1997 to 2022 at the Neonatal Intensive Care Unit at Department of Pediatrics, University Hospital Centre Zagreb. The characteristics of thoracic drainage and treatment modalities were described in patients with chylothorax, and patients with and without chylothorax were compared according to demographic and perinatal data, associated anomalies, morphological characteristics of the diaphragmatic defect, treatment, outcome, and the number and percentage of lymphocytes.
Results: 18 of the 81 (22%) analysed patients with CDH had chylothorax. All patients were treated conservatively. Chest drainage was used in all patients. Enteral feeding was stopped in 15 (83%) patients, and enteral feeding with high medium-chain triglyceride containing formulas was started in 10 (56%) patients. 2 (11.1%) patients with chylothorax died. There were no significant differences between two groups of patients in demographic and perinatal characteristics, morphological characteristics of the diaphragmatic defect, associated anomalies, methods of treatment, type of surgery and mortality. In patients with chylothorax, CDH was detected prenatally earlier (p=0.004). Patients with chylothorax required significantly longer mechanical ventilation (p<0.001) and were hospitalized longer (p<0.001). Patients with chylothorax had a lower minimum number (p=0.003) and percentage (p<0.001) of lymphocytes in the first 30 days of life and a lower average number of lymphocytes in the second, third and fourth week of life (p<0.001). Despite the lower number of lymphocytes, patients with chylothorax did not have a higher incidence of sepsis.
Conclusion: Chylothorax in patients with CDH increases morbidity but does not affect mortality. Chylothorax usually resolves with conservative treatment. In this paper, no risk factors for the occurrence of chylothorax in patients with CDH were found. Lymphopenia in patients with CDH is a possible laboratory marker indicating the development of chylothorax, however, additional research is needed. |
