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.