Individualised dietary treatment of congenital chylothorax

Background: The limited publications regarding congenital chylothorax focus on medical management, not therapeutic diet provision. Over a 14-month period, 4 infants were diagnosed with congenital chylothorax at the Great North Children’s Hospital. This abstract discusses variety in presentation and dietary treatment of these patients in and out of hospital, with the aim of sharing our experience of managing this rare condition. Methods: Medical communications and dietetic notes were reviewed. Results: Four infants (gestation 34 to 39 weeks) were diagnosed with congenital chylothorax antenatally. All required chest drains, 3 received ocreotide and 2 required total parenteral nutrition. One was diagnosed with Noonan like syndrome, had oral aversion and required gastrostomy feeding. One had tracheomalacia, had a tracheostomy and continuous positive airway pressure. In terms of dietetic treatment one infant has suspected cow’s milk allergy and was weaned from TPN to a modular amino acid based, low long chain triglyceride (LCT), medium chain triglyceride (MCT) rich feed. Two received monogen; one of these children required a carbohydrate energy module added to achieve good growth and the other fed in excess of their fluid requirement. One child received lipistart (a nut oil free, low LCT formula) due to maternal nut allergy. This required concentrating to increase calories delivered. Weaning diet provided 0.5g per day LCT per 6 months of life. MCT oil, low LCT recipes and advice was provided. All infants gained weight appropriately. Conclusion: Several options exist when treating congenital chylothorax with the low LCT diet. Individualised advice and support is key.