There was mention several days ago of Chylothorax and a criticism of the removal of breastfeeding. Lest someone accept a misinterpretation, I would like to add some information. Chylothorax is a buildup in the thoracic cavity of chylomicrons, which are derived from the lymphatic drainage from the gut. This is a potentially a very dangerous syndrome. Large chain triglycerides, derived from long chain fatty acids in the meal (breast milk, formula, etc) are automatically dumped into the lymph system which then passes through the thorax and dumps into the blood at the level of the heart. In some infants, this lympathic drainage is interrupted at the level of the thorax (due to trauma, etc) and the lymph dumps into the thoracic cavity, and causes the syndrome we call Chylothorax. Sometimes large volumes (100's of cc) of fluid can be drained from around the heart and lungs. The only treament for this is to feed medium chain triglycerides, which are transferred directly into the blood via the portal circulation. They are not transferred into the lymph, hence no chylomicrons. Therefore the lymph drainage of chylomicrons is decreased significantly and the chylothorax is reduced. Generally these will self-correct when given time, weeks, months, but only if the long chain triglycerides are removed from the diet. Many chylous effusions do not reaccumulate after approximately 2 weeks because the torn thoracic duct heals spontaneously. Therefore, removal of breast milk or formula is mandatory in this syndrome. This physician was correct in his/her therapy. Regards Tom Hale, Ph.D.