As the pathophysiology of chylothorax was discussed already, I will not
repeat any of that.  The reason Portagen is often recommended is that
its fats are mostly medium chained fatty acids, and these are absorbed
into the blood stream directly from the gut, and it is thought that this
will decrease the flow of chyle, decrease the amount of chylothorax the
baby will have, and allow more rapid closing of the defect, if there is
less flow of chyle.  Long chained fatty acids are absorbed into the
lymph and thus into the thoracic duct which is the structure thought to
be injured or defective in chylothorax.

        However, it does not follow from the above that breastmilk is
contraindicated.  It should be tried.  If this does not result in
increased chylothorax formation, that's fine.  Breastmilk could even be
tried in a graduated manner, so that if one feed a day seems not to
cause problems, two feeds could be tried and so on.

        The other question is why two months?  Babies heal very quickly and
what may not be possible on day 5 may be quite possible on day 20 or
even before.

        I think the surgeons are once again depending on their knowledge of
formula fed babies to determine management of the breastfed baby.

Jack Newman, MD, FRCPC