Chemical pleurodesis with povidone-iodine (Betadine) in congenital chylothorax: personal experience and review of literature

Česká verzia

Authors: Náhlovský Jiří ¹; Štichhauer Radek ²; Lešková Jana ²; Malý Jan ¹; Matějek Tomáš ¹
Authors place of work: Klinika dětské chirurgie a traumatologie, Lékařská fakulta v Hradci Králové, Univerzita Karlova a Fakultní nemocnice Hradec Králové ²
Published in the journal: Čes-slov Pediat 2024; 79 (1): 46-52.
Category: Original Papers
doi: https://doi.org/10.55095/CSPediatrie2023/055

Summary

Congenital chylothorax is a serious neonatal condition with high mortality and difficult management. Chemical pleurodesis can limit the need for surgical treatment, but there is no consensus on the optimal chemical agent for the lack of solid evidence. We report our experience with povidone-iodine (PVI) chemical pleurodesis in two neonates with congenital chylothorax. 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. In both cases, repeated doses of povidone-iodine were required to completely stop chyle formation. Based on our experience, chemical pleurodesis with povidone-iodine promptly and definitely stopped pleural effusion, with no side effect observed. Since its first use in 2003, we provide analysis of all published neonatal case reports concerning PVI chemical pleurodesis in congenital chylothorax (n = 20), with both success and survival rate at 80 %.

Zdroje

1. Attar MA, Donn SM. Congenital chylothorax. Semin Fetal Neonatal Med 2017; 22(4): 234–9.

2. Bellini C, Ergaz Z, Boccardo F, et al. Dynamics of pleural fluid effusion and chylothorax in the fetus and newborn: role of the lymphatic system. Lymphology 2013; 46(2): 75–84.

3. Bialkowski A, Poets CF, Franz AR, et al. Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed 2015; 100(2): F169–72.

4. Resch B, Sever Yildiz G, Reiterer F. Congenital chylothorax of the newborn: a systematic analysis of published cases between 1990 and 2018. Respiration 2022; 101(1): 84–96.

5. Buttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest 1999; 116(3): 682–7.

6. van Straaten HL, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur J Pediatr 1993; 152(1): 2–5.

7. Faul JL, Berry GJ, Colby TV, et al. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasia syndrome. Am J Respir Crit Care Med 2000; 161(3 Pt 1): 1037–46.

8. Chen CP, Chang TY, Wang W. Resolution of fetal bilateral chylothorax and ascites after two unilateral thoracocenteses. Ultrasound Obstet Gynecol 2001; 18(4): 401–2.

9. Chon AH, Chmait HR, Korst LM, et al. Long-term outcomes after thoracoamniotic shunt for pleural effusions with secondary hydrops. J Surg Res 2019; 233: 304–9.

10. De Angelis LC, Bellini T, Witte MH, et al. Congenital chylothorax: Current evidence based prenatal and post-natal diagnosis and management. Lymphology 2019; 52(3): 108–25.

11. Krishnamurthy Mohan Bagur, Atul M. Congenital chylothorax: current perspectives and trends. Res Report Neonatol 2017; 7: 53–63.

12. Moreira-Pinto J, Rocha P, Osorio A, et al. Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review. Pediatr Surg Int 2011; 27(8): 805–9.

13. Rimensberger PC, Muller-Schenker B, Kalangos A, et al. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998; 66(1): 253–4.

14. Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev 2010(9): Cd006388.

15. Church JT, Antunez AG, Dean A, et al. Evidence-based management of chylothorax in infants. J Pediatr Surg 2017; 52(6): 907–12.

16. Clark ME, Woo RK, Johnson SM. Thoracoscopic pleural clipping for the management of congenital chylothorax. Pediatr Surg Int 2015; 31(12): 1133–7.

17. Borcyk K, Kamil A, Hagerty K, et al. Successful management of extremely high output refractory congenital chylothorax with chemical pleurodesis using 4% povidone-iodine and propranolol: a case report. Clin Case Rep 2018; 6(4): 702–8.

18. Brissaud O, Desfrere L, Mohsen R, et al. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). Arch Dis Child Fetal Neonatal Ed 2003; 88(6): F531–3.

19. Hmami F, Oulmaati A, Bouchikhi C, et al. [Congenital chylothorax: rapid and complete response to polyvidone iodine]. Arch Pediatr 2014; 21(9): 1002–5.

20. Kasdallah N, Kbaier H, Ben Salem H, et al. Povidone iodine pleurodesis for refractory congenital chylothorax: a review of literature. Tunis Med 2016; 94(12): 834.

21. Le Nué R, Molinaro F, Gomes-Ferreira C, et al. Surgical management of congenital chylothorax in children. Eur J Pediatr Surg 2010; 20(5): 307–11.

22. Long WG, Cai B, Liu Y, et al. Povidone-iodine chemical pleurodesis in treating spontaneous chylothorax in pediatric patients. Ann Palliat Med 2020; 9(3): 1004-12.

23. Maoulainine F, Erguig L. Congenital chylothorax: rapid and effective response to polyvidone iodine. Open J Pediatrics 2016; 6: 10–3.

24. Mitanchez D, Walter-Nicolet E, Salomon R, et al. Congenital chylothorax: what is the best strategy? Arch Dis Child Fetal Neonatal Ed 2006; 91(2): F153–F4.

25. Murki S, Faheemuddin M, Gaddam P. Congenital chylothorax--successful management with chemical pleurodesis. Indian J Pediatrics 2010; 77(3): 332–4.

26. Resch B, Freidl T, Reiterer F. Povidone-iodine pleurodesis for congenital chylothorax of the newborn. Arch Dis Child Fetal Neonatal Ed 2016; 101(1): F87–8.

27. Scottoni F, Fusaro F, Conforti A, et al. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review. J Pediatr Surg 2015; 50(10): 1722–5.

28. Echavarría A, Pinzón V, Barés JP, et al. [Intracavitary treatment of malignant pleural effusion with iodine-povidone]. Rev Med Panama 1991; 16(1): 69–74.

29. Agarwal R, Khan A, Aggarwal AN, et al. Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis. Indian J Med Res 2012; 135(3): 297–304.

30. Mohsen TA, Zeid AA, Meshref M, et al. Local iodine pleurodesis versus thoracoscopic talc insufflation in recurrent malignant pleural effusion: a prospective randomized control trial. Eur J Cardiothorac Surg 2011; 40(2): 282–6.

31. Chisholm KM, Chang KW, Truong MT, et al. β-Adrenergic receptor expression in vascular tumors. Mod Pathol 2012; 25(11): 1446–51.