Propranolol as Salvage Therapy for Refractory Congenital Chylous Ascites in a Preterm Neonate: A Case Report and Review of the Literature

Background/Objectives: Congenital chylous ascites is a rare neonatal condition characterized by the accumulation of lymphatic fluid within the peritoneal cavity. The disorder can be difficult to manage, as many infants show limited response to standard conservative strategies such as dietary modification and supportive care. Currently, no universally accepted therapeutic guidelines exist. We report the successful use of propranolol in the management of refractory congenital chylous ascites. Methods: Clinical data were collected from a 35-week preterm male infant who had prenatal ultrasound evidence of fetal ascites from the 28th week of gestation. Postnatal management initially included fasting, total parenteral nutrition, and from day 9 of life, continuous infusion of octreotide. Due to the persistent ascites, oral propranolol was added to the therapy on the 31st day of life. Current literature was reviewed to compare our findings with those available. Results: Following the addition of propranolol to ongoing octreotide therapy, the infant demonstrated gradual clinical improvement with decreased abdominal distension and reduction of ascitic fluid; as propranolol and octreotide were administered concurrently for approximately 30 days, a causal effect could not be isolated to propranolol alone. Oral propranolol was administered at 0.5 mg/kg every 6 h (2 mg/kg/day total), with heart rate, blood pressure, and glucose monitored throughout treatment; no propranolol-related adverse events (bradycardia, hypotension, bronchospasm, hypoglycemia, or feeding intolerance) occurred. Ultrasonographic resolution of ascites was achieved by day 48, the peritoneal drainage catheter having already been removed on day 34; propranolol was subsequently tapered and discontinued by day 68, and the patient was discharged in stable condition on day 93, with no recurrence on serial ultrasound over the 45 days from resolution to discharge. A narrative review of the literature identified nine infants with lymphatic disorders successfully treated with propranolol. Conclusions: This case suggests a possible temporal association between propranolol administration and clinical improvement in a neonate with congenital chylous ascites refractory to conventional management; no propranolol-related adverse events were observed during treatment. Given the rarity of this condition and the absence of standardized treatment guidelines, further studies—potentially through multicenter registries or prospective case series—are warranted to establish optimal dosing strategies, evaluate long-term outcomes, and clarify the role of propranolol in this setting.