Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants




Chyloperitoneum, Chylothorax, Octreotide, Sirolimus, Newborns


Background: Chyloperitoneum (CP) and chylothorax (CT) are rare conditions that have a high mortality rate and unclear treatment options. Their incidence in neonates ranges from 1 in 20000 to 1 in 187000 live births. This study aims to evaluate the effectiveness of synthetic somatostatin analog (octreotide) and sirolimus therapy in treating chylous pleural and peritoneal collections in newborns and infants.

Methods: We conducted a retrospective analysis of 10 children with either chylothorax or chyloperitoneum, treated in our department between 2018 and 2023. The study was approved by the Local Independent Ethics Committee of The National Medical Research Center of Children's Health, under Protocol №7, dated 11 May 2023. The parents voluntarily signed an informed consent form for the off-label use of the drug. We reviewed the medical records for demographic information, clinical presentation, management, and outcome.

Results: Our study looked at patients aged between 0 and 5.5 months, with seven cases of chyloperitoneum and three cases of chylothorax. We initially used octreotide, which was then switched to sirolimus if there was no improvement. Octreotide was effective in five children after 10-18 days of treatment, while the effect of sirolimus was observed 8-14 days after starting treatment. One patient, who had a history of a giant omphalocele with primary closure, experienced complications after 8 weeks of sirolimus therapy, including bilateral knee arthritis, leukopenia, and lymphopenia. Fortunately, there were no fatal outcomes.

Conclusion: Sirolimus therapy is effective in treating newborns with chylothorax or chyloperitoneum, with a low risk of complications even in those cases not responding to octreotide therapy. It is recommended that octreotide therapy should not exceed 10 days, after which sirolimus can be prescribed.


Download data is not yet available.


Metrics Loading ...


Albaghdady A, El-Asmar K, Moussad M, Abdelhay S. Surgical management of congenital chylous ascites. Ann Pediatr Surg. 2018;14(2):56-9.

Kucherov YI, Yashina EV, Zhirkova YV. [A clinical case of simultaneous treatment of chylothorax, chylopericardium, and chyloperitoneum in a newborn]. Russ J Pediatr Surg. 2016;6(1):95-9. Russian.

Wang B, Feng Y, Guo Y, Kan Q, Zou Y, Wu Y, et al. Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China. J Cardiothorac Surg. 2022;17:276.

Kucherov YI, Kholodnov NV, Adleiba SR, Belaya AL, Makarova LM, Ovsyannikova MA, et al. [Chyloperitoneum in newborns: etiology, pathogenesis, diagnostics, and treatment]. Russ J Pediatr Surg. 2019;23(3):139-142. Russian.

Rudakova EA, Kovaleva OA, Openysheva AV, Koroleva MA. [Results of treatment of chyloperitoneum in a newborn]. Permskiy meditsnskiy zhurnal. 2015;32(6):78-83. Russian.

Saziye K, Gino G, Afksendiyos K. Somatostatin treatment of persistent chyloperitoneum following abdominal aortic surgery. J Vasc Surg. 2012;56(5):1409-12.

Ilaria A, Mariarosa C, Genny R, Giacomo C, Fabrizio C, Silvana G, et al. The use of sirolimus in the treatment of giant cystic lymphangioma: Four case reports and update of medical therapy. Medicine (Baltimore). 2017;96(51):e8871.

Donyush EK, Kondrashova ZA, Polyaev YA, Garbuzov RV. [Experience of using sirolimus in the treatment of children with vascular anomalies]. Russ J Pediatr Hematol Oncol. 2020;7(3):22-31 Russian.

Kireeva NB, Pivikov VE, Novopoltsev EA, Tumakova NB, Plokharsky NA, BiryukovYP, et al [Chylothorax and chyloperitoneum in newborns: 4 case report]. Russ J Pediatr Surg. 2016;6(4):88-90 Russian.

Attar MA, Donn SM. Congenital chylothorax. Semin Fetal Neonatal Med. 2017;22(4):234-9.

Antao B, Croaker D, Squire R. Successful management of congenital chyloperitoneum with fibrin glue. J Pediatr Surg. 2003;38(11):E54.

BK, Mahajan P, Fernandes CJ, Margolin JF, Iacobas I. Sirolimus efficacy in the treatment of critically ill infants with congenital primary chylous effusions. Pediatr Blood Cancer. 2022;69:e29510.

Karagol BS, Zenciroglu A, Gokce S, Kundak AA, Ipek MS. Therapeutic management of neonatal chylous ascites: Report of a case and review of the literature. Acta Paediatr. 2010;99:1307-10.

Bhatia C, Pratap U, Slavik Z. Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum. Arch Dis Child. 2001;85:234-5.

Roehr CC, Jung A, Proquitté H, Blankenstein O, Hammer H, Lakhoo K, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32:650-7.

Bellini C, Cabano R, De Angelis LC, Bellini T, Calevo MG, Gandullia P, et al. Octreotide for congenital and acquired chylothorax in newborns: a systematic review. J Paediatr Child Health. 2018;54(8):840-7.

Reck-Burneo CA, Parekh A, Velcek FT. Is octreotide a risk factor in necrotizing enterocolitis? J Pediatr Surg. 2008;43:1209-1210.

Scottoni F, Fusaro F, Conforti A, Morini F, Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review. J Pediatr Surg. 2015;50:1722-5.

Parkhitko AA, Favorova OO, Khabibullin DI, Anisimov VN, Henske E.P. Kinase mTOR: Regulation and role in maintenance of cellular homeostasis, tumor development, and aging. Biokhimiya. 2014;79(2):128-43.

Mizuno T, Fukuda T, Emoto C, Mobberley-Schuman PS, Hammill AM, Adams DM, et al. Developmental pharmacokinetics of sirolimus: Implications for precision dosing in neonates and infants with complicated vascular anomalies. Pediatr Blood Cancer. 2017;00:e26470.




How to Cite

Gurskaya A, Sulavko M, Ekimovskaya E, Bayazitov R, Nakovkin O, Karnuta I, Klepikova A, Akhmedova D, Hagurov R, Sagoyan G. Somatostatin analog (octreotide) and sirolimus immunosuppressive therapy in the treatment of chyloperitoneum and chylothorax in newborns and infants. J Neonatal Surg [Internet]. 2024Jan.3 [cited 2024Jul.21];13:3. Available from:



Original Article