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An international survey of the nutrition management of chylothorax: a time for change

Published online by Cambridge University Press:  15 August 2019

L. V. Marino Open the ORCID record for L. V. Marino [Opens in a new window] ,
K. L. Bell ,
J. Woodgate ,
A. Doolan  and
British Dietetic Association Paediatric Cardiology Interest Group
L. V. Marino*
Affiliation:
Department of Dietetics/SLT NIHR Biomedical Research Centre Southampton, Faculty of Health Sciences University Hospital Southampton NHS Foundation Trust and University of Southampton University of Southampton
K. L. Bell
Affiliation:
Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
J. Woodgate
Affiliation:
Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
A. Doolan
Affiliation:
Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
British Dietetic Association Paediatric Cardiology Interest Group
Affiliation:
Department of Dietetics/SLT NIHR Biomedical Research Centre Southampton, Faculty of Health Sciences University Hospital Southampton NHS Foundation Trust and University of Southampton University of Southampton Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
*
Author for correspondence: Dr L. Marino, Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, S016 6YD, UK. Tel: + 44 (0) 23 8079 6000; E-mail: luise.marino@uhs.nhs.uk
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Abstract

Introduction:

Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research.

Materials and methods:

A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration.

Results:

In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians’ preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5 g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001).

Conclusions:

This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.

Keywords

ChylothoraxnutritionpracticeCHDinfants
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 9 , September 2019 , pp. 1127 - 1136
Copyright
© Cambridge University Press 2019 

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