Chylothorax results from lymph leaking into the thoracic cavity.  It occurs
without obvious reason in some babies, and, as in this case, it can occur
from damage to the thoracic duct during surgery. It will almost always heal
spontaneously, but healing is supposed to be more rapid if the lymph flow is
decreased.

The idea of using Portagen is that it contains only medium chained fatty
acids which are absorbed straight into the blood from the gut, and do not go
into the lymph.  Thus there will be decreased lymph flow.  The fats of
breastmilk go into the lymph, at least most of them.

My approach would be to feed the baby breastmilk and see what happens.  Who
says that breastmilk would work the same as formula?  We are just assuming
that.  It might, but it might not. Let's try first.

However, here is another plan.  Why use Portagen?  Why not feed the baby
expressed milk, which has been spun down so that the fat can be taken off,
and that fat be replaced with medium chained fatty acids.  Shouldn't be too
difficult to do.  The baby gets breastmilk and the antibodies and the whole
bit.

Jack Newman, MD, FRCPC

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