Neonatal chylous ascites - report of three cases and review of the literature

Abstract

Three cases of neonatal chylous ascites (CCA) were managed in the neonatal unit, University Hospital, Kuala Lumpur, over the past 9 years. Fetal ascites and polyhydramnios were the sole abnormalities detected in all three babies by antenatal ultrasonography. They were born at 36 weeks' gestation and their birth weights ranged from 3.0 kg to 3.8 kg. All three infants had abdominal distension at birth. Milky ascitic fluid was obtained after starting enteral feedings. Analysis of the ascitic fluid revealed a raised white blood cell count (predominantly lymphocytic) and triglycerides (1.4 - 3.8 mmol/l), cholesterol (1.6 - 2.8 mmol/l), and protein levels (25 - 41 g/l). Conservative management with skimmed milk and medium-chain triglycerides in one infant and Pregestimil in another was instituted. these two infants with CCA were clinically normal when reviewed at 19 months and 3.5 years of age. The third infant had a gut malrotation and associated pyloric septum; he died from complications of a laparotomy. The literature on this rare condition is reviewed.

Successful laparoscopic ligation of the lymphatic trunk for refractory chylous ascites

“…Nonsurgical treatments such as low-fat milk, formulas in which the fat is replaced with medium-chain triglycerides, and total parenteral nutrition are initially carried out because of the benign nature of the disease and better responsiveness to conservative therapy [1,7]. However, in our case, the chylous ascites was completely not cured and recurred 2 years after the conservative therapies.…”

A newborn with chylous ascites caused by intestinal malrotation associated with heterotaxia syndrome

“…In neonatal chylous ascites data on treatment is scant. Surgery is recommended for those unresponsive to medical management or with correctable intra-abdominal pathologies [5]. Our patient was successfully treated with a combination of peritoneal drainage, surgical correction of the malrotation, and use of a formula containing medium-chain triglycerides.…”

Refractory Congenital Chylous Ascites

“…More than 50% of clinical cases occur in infants, especially during the first two months of life [1,2].…”

“…Congenital chylous ascites (CCA) is a rare condition which is usually treated conservatively [1,2]. Cases of refractory CCA in neonates are scarce in the literature and no gold standard treatment has been defined so far [3,4].…”