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Case report
Management of large congenital chylous ascites in a preterm infant: fetal and neonatal interventions
  1. Loo Sooklin1,
  2. Amudha Jayanthi Anand1,2,3,4,
  3. Victor Samuel Rajadurai1,2,3,4 and
  4. Suresh Chandran1,2,3,4
  1. 1Neonatology, KK Women's and Children's Hospital, Singapore
  2. 2Paediatrics, Lee Kong Chian School of Medicine, Singapore
  3. 3Paediatrics, Yong Loo Lin School of Medicine, Singapore
  4. 4Paediatrics, Duke NUS Medical School, Singapore
  1. Correspondence to Professor Suresh Chandran; profschandran2019{at}gmail.com

Abstract

Congenital chylous ascites is a rare cause of ascites in newborn infants. Its aetiology varies from localised leaky lymphatic duct to genetic syndromes. Most of these cases have transient ascites resolving over time with conservative management but some may progress needing medical as well as surgical treatment. We describe a case of antenatally detected large fetal ascites necessitating abdominal paracentesis and amnioreduction. Marked respiratory distress at birth required urgent abdominal paracentesis to relieve symptoms. The infant initially showed a good response to medium chain triglyceride (MCT) based formula milk feeds. Feeds were discontinued for 3 weeks due to sepsis with ileus. On recovery, recommencement of feeds resulted in reaccumulation of ascites. As the response to MCT-based formula was inadequate, octreotide therapy was initiated. Ascites showed remarkable resolution over the next 2 weeks and was discharged home. Follow-up at 5 years of age revealed normal growth and neurodevelopment.

  • nutrition
  • neonatal intensive care
  • congenital disorders
  • ultrasonography

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Footnotes

  • LS and AJA are joint first authors.

  • Contributors LS involved in manuscript preparation and review of literature. AJA involved in manuscript preparation. VSR and SC involved in reviewing and editing the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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