Chylothorax
Conditions
Keywords
breast milk, infants, chylothorax, cardiac surgery, modified breast milk
Brief summary
Chylothorax occurs in \ 3 to 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. Hypothesis: The investigators primary hypothesis was that infants fed MBM would have more chyle drainage in the first 5 days after diagnosis compared to infants fed an MCT based formula which is the current standard of care. Design: Infants with chylothorax were eligible. Treatment infants (n=8) received mother's own milk that had been modified by removing the fat layer via centrifugation and adding MCT and nutrients to provide 67 kcal/mL and 11 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. Outcome measures collected included chyle drainage from chest tubes, weight, length and head circumference measurements and estimated energy and nutrient intake.
Interventions
OTHERFat-Modified Breast Milk
OTHERMCT formula
Sponsors
Labatt Family Heart Centre
Trainee award through Ontario Student Opportunity Trust Fund - The Hospital for Sick Children Foundation Scholarship
The Hospital for Sick Children
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 12 Months
Healthy volunteers
No
Inclusion criteria
* Infants \< 12 months of age who were diagnosed with chylothorax. * Infants included in the intervention group (MBM) needed to have received \>80% of their enteral feeds as breast milk prior to surgery. * Infants included in the control group (MCT-formula) needed to have received \<80% of their enteral feeds as breast milk prior to surgery.
Exclusion criteria
* Subjects were excluded if their diagnosis made it unlikely that they would be able to follow the hospital's standard 6 week protocol for treatment of chylothorax * Were receiving only parenteral nutrition at the time of diagnosis of chylothorax * Primary caregiver of the baby did not have good comprehension of English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chyle Drainage from Chest Tubes | 6 weeks of chylothorax treatment | This outcome includes measurement of chyle drainage from chest tubes in the first 5 days after diagnosis of chylothorax and the number of days of chest tube drainage. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Growth | 6 weeks of the chylothorax treatment | Infant weight, length and head circumference measurements were determined at study initiation and at the first post-discharge follow-up visit (within one-week of discharge) and again at the end of chylothorax treatment. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Estimated Nutrient Intakes | 6 weeks of chylothorax treatment | Average daily energy, protein and other nutrient intakes were calculated using milk volumes consumed (recorded in the medical record \[in-hospital\] or 3 day consecutive food records \[after discharge\]), analyzed breast milk fat composition values, milk nutrient values from the literature, product monographs and Food Processor SQL Ed v. 10.2 (ESHA Research). |
Countries
Canada
Outcome results
None listed