Fat-Modified Breast Milk Resolves Chylous Pleural Effusion in Infants With Postsurgical Chylothorax but Is Associated With Slow Growth
Fat-Modified Breast Milk Resolves Chylous Pleural Effusion in Infants With Postsurgical Chylothorax but Is Associated With Slow Growth
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DOI：
10.1177/0148607114566464
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发表时间：
2016-05-01
影响因子：
3.4
通讯作者：
O'Connor, Deborah L.
中科院分区：
文献类型：
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作者：
Kocel, Sarah L.;Russell, Jennifer;O'Connor, Deborah L.
背景：接受心脏手术的婴儿中约有 3%-5% 会出现乳糜胸。由于长链甘油三酯含量丰富，标准治疗需要停止母乳喂养，转而采用中链甘油三酯 (MCT) 配方奶粉。目的：确定脂肪改良母乳 (MBM) 与 MCT 配方奶粉相比治疗乳糜胸的有效性。材料和方法：2008 年 1 月至 2009 年 12 月期间在病童医院接受先天性心脏病手术后诊断出乳糜胸的婴儿有资格参加这项非随机开放标签研究。治疗婴儿 (n=8) 接受母乳，母乳通过离心去除脂肪层并添加 MCT、营养素和必需脂肪酸进行改良，可提供估计 74 kcal/100 mL 和 1.4 g/100 mL 蛋白质（MBM 组）。对照婴儿 (n = 8) 接受 MCT 配方奶粉（MCT 组）。根据病童医院标准乳糜胸治疗方案，在拔除胸管后至少 6 周进行喂养干预。结果：MBM 组和 MCT 组之间每日胸管引流量和持续时间没有差异。虽然喂养组之间的体重增加率 (g/d) 没有统计学上的显着差异，但 MBM 组的婴儿往往更年轻，年龄 z 评分的平均体重 (P = .04) 和身长 (P = .01) 均出现下降。结论：脂肪改良母乳解决了乳糜胸问题；然而，在临床广泛采用这种新疗法之前，需要制定解决生长不良的策略并在更大规模的试验中进行评估。
Background: Chylothorax occurs in similar to 3%-5% of infants undergoing cardiac surgery. Standard treatment requires discontinuation of breast milk feeding, due to the abundance of long-chain triglycerides and transition to a medium-chain triglyceride (MCT)-based formula. Objective: To determine the effectiveness of fat-modified breast milk (MBM) for the treatment of chylothorax compared with MCT formula. Materials and Methods: Infants diagnosed with chylothorax following surgery for congenital heart disease between January 2008 and December 2009 at The Hospital for Sick Children were eligible for this nonrandomized open-label study. Treatment infants (n=8) received mother's own milk that had been modified by removing the fat layer via centrifugation and adding MCT, nutrients, and essential fatty acids to provide an estimated 74 kcal/100 mL and 1.4 g/100 mL protein (MBM group). Control infants (n = 8) received an MCT formula (MCT group). The feeding intervention was a minimum of 6 weeks after chest tube removal per The Hospital for Sick Children standard chylothorax treatment protocol. Results: Daily volume and duration of chest tube drainage were not different between the MBM and MCT groups. While there was no statistically significant difference in rates of weight gain (g/d) between feeding groups, infants in the MBM group, who tended to be younger, experienced a decline in mean weight (P = .04) and length (P = .01) for age z scores. Conclusion: Fat-modified breast milk resolved chylothorax; however, strategies to address poor growth need to be developed and evaluated in larger trials prior to widespread clinical adoption of this novel treatment.