Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review

Research output: Contribution to journalReview article

Abstract

INTRODUCTION: Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment.

METHODS: Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4% povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours.

RESULTS: Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment.

CONCLUSION: Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.

Original languageEnglish
Pages (from-to)1722-1725
Number of pages4
JournalJournal of Pediatric Surgery
Volume50
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

Fingerprint

Pleurodesis
Chylothorax
Povidone-Iodine
Newborn Infant
Total Parenteral Nutrition
Superior Vena Cava Syndrome
Thoracic Duct
Octreotide
Pleural Effusion
Ligation
Fatty Acids
Diet
Safety
Injections

Keywords

  • Chemical pleurodesis
  • Chylothorax
  • Neonatal pleural effusion
  • Pleurodesis with povidone–iodine
  • Refractory chylothorax

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{05d458a70766426287c65dc001418b9f,
title = "Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review",
abstract = "INTRODUCTION: Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment.METHODS: Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4{\%} povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours.RESULTS: Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment.CONCLUSION: Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.",
keywords = "Chemical pleurodesis, Chylothorax, Neonatal pleural effusion, Pleurodesis with povidone–iodine, Refractory chylothorax",
author = "Federico Scottoni and Fabio Fusaro and Andrea Conforti and Francesco Morini and Pietro Bagolan",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.jpedsurg.2015.03.069",
language = "English",
volume = "50",
pages = "1722--1725",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
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TY - JOUR

T1 - Pleurodesis with povidone-iodine for refractory chylothorax in newborns

T2 - Personal experience and literature review

AU - Scottoni, Federico

AU - Fusaro, Fabio

AU - Conforti, Andrea

AU - Morini, Francesco

AU - Bagolan, Pietro

PY - 2015/10/1

Y1 - 2015/10/1

N2 - INTRODUCTION: Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment.METHODS: Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4% povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours.RESULTS: Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment.CONCLUSION: Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.

AB - INTRODUCTION: Refractory chylothorax is a severe clinical issue, particularly in neonates. Conventional primary approach is based on diet with medium-chain fatty acids and/or total parenteral nutrition. In nonresponders, proposed second line treatments include chemical or surgical pleurodesis, thoracic duct ligation, pleuroperitoneal shunting and pleurectomy but none of these have been shown to be superior to other in terms of resolution rate and safety. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment. Our aim is to report our experience on povidone-iodine use for chemical pleurodesis in newborn infants with chylothorax unresponsive to conservative treatment.METHODS: Since 2013, povidone-iodine pleurodesis was attempted in all patients with persistent chylothorax who failed conservative treatment (no response to at least 10 days of total parenteral nutrition and maximum dosage of intravenous octreotide). Pleurodesis consisted in the injection of 2 ml/kg of a 4% povidone-iodine solution inside the pleural space, leaving the pleural tube clamped for the subsequent 4 hours.RESULTS: Five patients were treated with chemical pleurodesis of persistent chylothorax. Four of 5 patients had their pleural effusion treated by one single povidone-iodine infusion. Median time for resolution was 4 days. A patient with massive superior vena cava thrombosis did not benefit from pleurodesis. None of the patients experienced long term side effects of the treatment.CONCLUSION: Our data suggest that povidone-iodine pleurodesis may be considered a safe and effective option to treat refractory chylothorax in newborns.

KW - Chemical pleurodesis

KW - Chylothorax

KW - Neonatal pleural effusion

KW - Pleurodesis with povidone–iodine

KW - Refractory chylothorax

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U2 - 10.1016/j.jpedsurg.2015.03.069

DO - 10.1016/j.jpedsurg.2015.03.069

M3 - Review article

C2 - 25969129

VL - 50

SP - 1722

EP - 1725

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 10

ER -