SIROLIMUS EFFICACY IN THE TREATMENT OF CRITICALLY- ILL INFANTS WITH
CHYLOUS EFFUSIONS
Abstract
Background: While rare in children, chylothorax is a significant cause
of respiratory morbidity and can lead to malnutrition and
immunodeficiency. Historically, the traditional pharmacological
treatment has been octreotide. There are several treatments that have
been utilized in the past few years including sirolimus, however data
regarding their efficacy and outcomes is limited. Furthermore, sirolimus
has proven efficacy in complex vascular malformations, and hence, its
utility/efficacy in pediatric chylous effusions warrants further
investigation. Methods: In this retrospective study at Texas Children’s
Hospital, data were extracted for all patients with chylothorax who were
treated with sirolimus between 2009 and 2020. Details regarding
underlying diagnosis, co-morbidities and number of days from sirolimus
initiation to resolution of effusion were collected. Descriptive
statistics were used to analyze the study cohort. Results: Initially a
total of twelve infants were identified. Among them, seven patients had
complete data and were included in the study. The mean duration of
sirolimus treatment needed for chest tube removal was 16 days, with a
median of 19 days and range of 7- 22 days. Chest tube output
corresponded with sirolimus serum trough levels and trended down prior
to chest tube removal. Conclusion: With close monitoring, sirolimus is a
safe and effective therapy for pediatric lymphatic effusions even in
critically-ill infants. The study also demonstrates shorter duration of
chest tube requirement after initiation of sirolimus compared to
previous studies. Our conclusion is based on a small case series due to
the rare incidence of the condition.