Success rates of conservative treatment and optimal surgical timing for pediatric chylothorax.

Background: Pediatric chylothorax poses management challenges, with conservative treatment as the first-line approach and surgery reserved for persistent cases. However, data remain limited on factors related to conservative treatment success and optimal surgical timing.

Purpose: This study aimed to evaluate the success rate of conservative treatment, identify the associated factors, and determine the optimal timing for surgical intervention.

Methods: We retrospectively reviewed pediatric chylothorax cases at Siriraj Hospital treated between January 2012 and December 2022. Clinical and laboratory parameters, treatment modalities, and outcomes were analyzed.

Results: Thirty pediatric patients were included (median age, 1.7 months); 67% were male. Conservative treatment had an overall success rate of 83.3% (25 of 30) and a 95% (19 of 20) success rate among patients with chylothorax after congenital heart disease surgery. Among the factors associated with successful conservative treatment, chylothorax caused by surgery was associated with a significantly higher success rate than nonsurgical causes (91.7% vs. 50%, respectively; P=0.04). The successful group exhibited a significantly lower peak pleural fluid flow rate than the unsuccessful group (26.8 mL/kg/day vs. 91 mL/kg/day, P=0.002). A time-to-event analysis showed that the success rate of conservative treatment for postsurgical chylothorax was 78% at 14 days, suggesting that 2 weeks may be the optimal timing for surgical intervention.

Conclusion: Conservative treatment is an effective first-line treatment for pediatric chylothorax. The etiology and peak flow rate of pleural fluid drainage are associated with its success. Optimized surgical intervention timing is crucial for improving outcomes.