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Case report
Necrotising enterocolitis in a newborn infant treated with octreotide for chylous effusion: is octreotide safe?
  1. Suresh Chandran1,2,3,4,
  2. Arpan Agarwal1,2,3,
  3. Genevieve Villablanca Llanora1 and
  4. Mei Chien Chua1,2,3,4
  1. 1Department of Neonatology, KK Women's and Children's Hospital, Singapore
  2. 2Department of Neonatology, Duke NUS Medical School, Singapore
  3. 3Department of Neonatology, NUS Yong Loo Lin School of Medicine, Singapore
  4. 4Department of Neonatology, Lee Kong Chian School of Medicine, Singapore
  1. Correspondence to Professor Suresh Chandran; profschandran2019{at}gmail.com

Abstract

Octreotide is a somatostatin analogue used for treating congenital chylothorax and congenital hyperinsulinism in infants. By increasing splanchnic arteriolar resistance and decreasing gastrointestinal blood flow, octreotide indirectly reduces lymphatic flow in chylous effusions.

Splanchnic ischaemia following octreotide predisposes infants to necrotising enterocolitis (NEC). Although NEC occurrence in infants treated with octreotide for hyperinsulinaemic hypoglycaemia has been reported widely, its incidence in infants with chylothroax is low. We describe a case of congenital chylothorax in a preterm infant who had poor response to thoracentesis. Although octreotide initiation lead to resolution of chylothorax, he developed NEC. Cessation of octreotide and medical management resulted in rapid resolution of NEC. Since octreotide is generally used as the first-line treatment for chylous effusion, the risk of NEC should be considered, especially when the dosage is increased. Infants on octreotide should be closely observed for early signs and symptoms of NEC to avert surgical emergency.

  • congenital disorders
  • gastrointestinal system
  • safety
  • unwanted effects / adverse reactions
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Footnotes

  • Contributors AA and GVL: manuscript preparation and literature review. SC and CMC: manuscript preparation, literature review and finalisation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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