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  1. To obtain peritoneal fluid for diagnostic tests to determine the cause of ascites. Ascites is an excessive amount of fluid in the peritoneal cavity, and in the neonate, it is usually urinary, biliary, or chylous. Other causes can occur but are less common.

    1. Urinary ascites. Due to perforation of the ureter, renal pelvis, or bladder (often caused by a distal urinary tract obstruction and proximal buildup of pressure). The most common neonatal cause is posterior urethral valves. Rare causes: ureterocele, ureteral or urethral stenosis, persistent cloaca, neurogenic bladder, urogenital sinus, congenital nephrotic syndrome, bladder neck obstruction, and renal vein thrombosis.

    2. Biliary ascites. Due to perforation in the extrahepatic biliary tree (most common site is junction of common bile duct with cystic duct), injury to the bile ducts, or a choledochal cyst.

    3. Chylous ascites. Usually idiopathic. Causes include: congenital chylous ascites (most commonly caused by a malformation of the lymphatic duct causing an obstruction or inadequate drainage of the intraabdominal lymphatic system), “leaky lymphatics,” lymphangiectasia, external compression (malrotation, intussusception, mesenteric cyst, incarcerated hernia), complication following neonatal surgery and others.

    4. Hepatocellular ascites. Can be caused by neonatal hepatitis, viral hepatitis, α1-antitrypsin deficiency, congenital hepatic fibrosis, storage disorders, Budd-Chiari syndrome, or hepatic/portal vein thrombosis.

    5. Pancreatic ascites. Usually caused by trauma, infection, anatomical lesions, congenital pancreatic pseudocyst.

    6. Gastrointestinal tract causes of ascites. Any perforation of the gastrointestinal tract: necrotizing enterocolitis (NEC) with perforation/peritonitis, meconium peritonitis, perforation of the Meckel diverticulum, atresia, malrotation, volvulus, gastroschisis, omphalocele, post abdominal surgery, or intussusception. Peritonitis in neonates is most commonly associated with gastrointestinal perforations.

    7. Infections. Most commonly congenital (cytomegalovirus [CMV], toxoplasmosis, syphilis, and others) but can also be from fungal (most common Candida albicans), viral (parvovirus, enterovirus), or bacterial infections (tuberculosis, salmonella).

    8. Inborn errors of metabolism. Glycogen storage disorders, lysosomal storage disorders, and galactosemia can all cause ascites. Examples include infantile free sialic acid storage disorder (ISSD), Salla disease, GM1 gangliosidosis, Gaucher disease, and α1-antitrypsin deficiency.

    9. Cardiac abnormalities. Congestive heart failure, arrhythmias, and right-sided heart obstruction.

    10. Chromosomal causes. Turner syndrome and trisomy 21.

    11. Iatrogenic. Can occur from fluid from central venous catheters or intraperitoneal extravasation of fluids from an umbilical vein catheterization–related perforation, gastric perforation from gastric tubes.

    12. Hemoperitoneum (bloody ascites). Uncommon but can be nontraumatic (hepatoblastoma), secondary to birth trauma (hepatic, splenic, or adrenal), or secondary to a ruptured internal organ. Splenic trauma can be associated with consumptive coagulopathy.

  2. As a therapeutic procedure to relieve pressure and aid in ventilation in a patient with cardiorespiratory compromise. Examples include removal of peritoneal fluid from massive ascites or air from a pneumoperitoneum.


Sterile drapes, sterile gloves, topical disinfectant (eg, povidone-iodine solution), sterile gauze pads, tuberculin syringe, 1% lidocaine (see pain management options later in this chapter [Section III.G]), appropriate sterile collection tubes for fluid, a 5- to 20-mL syringe on a 3-way stopcock, 22- or 24-gauge catheter-over-needle assembly (24 gauge for <2000 g, 22–24 ...

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