[Neonatal chylous ascites: report of two cases]

Chylous ascites in neonates is an unusual and etiologically poor understood entity. Our first case was a female newborn who suffered from abdominal distension and recurrent vomiting after birth. The history, physical, laboratory, and radiologic evaluations were not diagnostic except the evidence of obvious ascites. Paracentesis was performed and ascitic fluid was obtained. She was later discharged on a strict low-fat medium-chain triglycerides formula. She was found to have continue increase in abdominal girth, poor growth and development, and respiratory distress in which led her to readmission at 8 months of age. Exploratory laparotomy was done in order to rule out an anatomical lesion in which may be obstructing the lymphatic flow; but no such lesion could be found. She expired at 1 year of age with chylothorax, chylopericardium and lobar pneumonia. The second case, a 37-day-old male baby, who was admitted because of right inguinal hernia. Milky ascitic fluid in the abdomen was incidentally found during herniorrhaphy. Analysis of the fluid revealed protein 1,616 mg/dl, glucose 487 mg/dl, and triglyceride 796 mg/dl. Culture of peritoneal fluid grew no bacteria. Other laboratory findings were: serum protein 4.8 mg/dl, and BUN 14 mg/dl. A plain film of abdomen and sonogram showed massive ascites. The infant was then put on Pregestimil with the hope that the medium-chain triglyceride formula would improve his condition. Since then the child's abdominal girth did not increase and he continued to growth and develop normally at 4 months follow up.