Early Stabilization and Supportive Management of Congenital Ascites in Non-Immune Hydrops Fetalis: A Rare Case Report

Abstract

Background: Congenital ascites, considered part of the spectrum of non-immune hydrops fetalis (NIHF), is a rare clinical condition characterized by diverse underlying etiologies and variable outcomes, posing significant challenges in both diagnosis and management

Case Presentation: We report a term neonate who presented with massive ascites associated with respiratory compromise. Ascitic fluid analysis demonstrated an exudative profile, characterized by elevated protein levels and marked mononuclear cell predominance, raising suspicion of an underlying lymphatic disorder or chronic inflammatory process. Imaging studies revealed isolated ascites accompanied by bilateral hydroceles, with no other significant structural abnormalities. Cardiac and endocrine evaluations were unremarkable. During hospitalization, the patient developed pneumonia and subsequently received appropriate antimicrobial therapy.

Discussion: Management was performed using a structured, stepwise, and predominantly non-invasive approach, including escalation of respiratory support, fluid restriction, diuretic therapy, and gradual nutritional optimization. The patient showed progressive clinical gfhimprovement with resolution of ascites without invasive intervention. These findings support evidence that selected cases of isolated fetal ascites may respond favorably to conservative management. In addition, timely intrauterine interventions such as amnioreduction and fetal paracentesis have been associated with improved survival rates exceeding 90% in cases presenting after 28 weeks with surgically correctable etiologies.

Conclusion: This case highlights the importance of individualized, physiology-based management in neonates with congenital ascites, particularly when the underlying etiology remains uncertain. Careful integration of clinical findings, laboratory results, and imaging may facilitate appropriate therapeutic decision-making and contribute to favorable clinical outcomes.