Neonatal Ascites

Neonatal ascites is a rare condition characterized by the accumulation of fluid in the intraperitoneal cavity. The most common types of ascites caused by surgical disorders in neonates are classified as urinary, chylous, and bilious. Urinary ascites occurs mostly in boys who have an obstruction of the urinary tract, such as posterior urethral valves. These patients may present with signs of renal insufficiency, and the aim of treatment is to achieve decompression of the urinary tract. Chylous ascites is an accumulation of lipid-rich lymph in the peritoneal cavity most commonly due to an obstruction of the lymphatic system secondary to congenital malformation of the lymphatic channels. Diagnosis is typically achieved by paracentesis to confirm the presence of chyle, and treatment is usually conservative with enteral diet containing medium-chain triglycerides. Bilious ascites usually results from spontaneous perforation of the bile duct, a rare condition with an unknown cause. Patients have fluctuating mild jaundice, normal to acholic stools, and slowly progressive ascites. Imaging studies, such as the hepatobiliary scintigraphy, confirm the diagnosis. Surgical intervention is required.