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Implementation of the Use of Skimmed Breast Milk and the Registered Dietitian Nutritionist’s Role

      Chylothorax is defined as the accumulation of chyle within the pleural space.
      • Mueller C.
      • McClave S.
      • Kuhn J.M.
      The A.S.P.E.N. Adult Nutrition Support Core Curriculum.
      Infants can develop chylothorax due to congenital malformations or secondary to surgical procedures, including cardiac surgery and other surgery that might damage the thoracic duct and disrupt lymph flow.
      • Mueller C.
      • McClave S.
      • Kuhn J.M.
      The A.S.P.E.N. Adult Nutrition Support Core Curriculum.
      • Soto-Martinez M.
      • Massie J.
      Chylothorax: Diagnosis and management in children.
      Infants with chylothorax are at significant nutrition risk and can develop muscle wasting, weight loss, and malnutrition. Nutrition management is a cornerstone of the medical management of chylothorax. Long-chain triglycerides (LCTs) that are absorbed from the gut become part of the lymphatic flow and need to traverse the thoracic duct to reach the bloodstream to avoid worsening the chylothorax. Therefore, nutrition management includes restriction of LCTs. The diet needs to be high in medium-chain triglycerides (MCTs), which are absorbed directly into the portal vein. If unable to use the gastrointestinal tract to feed, parenteral nutrition can be initiated where LCTs can be provided because the lymphatic flow is bypassed.
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      References

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      1. Mead Johnson Enfaport product information. Healthcare Professional Resource Center website. https://www.meadjohnson.com/pediatrics/us-en/product-information/products/medical/enfaport#nutrients-sup-sup. Updated December 27, 2017. Accessed December 5, 2017.

      2. Food and Nutrition Board, Institute of Medicine, National Acadamies. Dietary Reference Intakes (DRI): Recommended Dietary Allowances and Adequate Intakes, Vitamins. https://www.ncbi.nlm.nih.gov/books/NBK56068/table/summarytables.t2/?report=objectonly. Updated 2011. Accessed December 5, 2017.