Congenital chylothorax is a rare condition. It is the commonest cause of pleural effusion causing respiratory distress in the neonatal period. The optimal method of treatment remains controversial. Currently, conservative treatment includes the use of a lowfat highprotein diet, supplemented with medium chain triglycerides or total parenteral nutrition combined with pleural drainage. The frequency and timing of spontaneous resolution is variable. Recent reports have suggested that somatostatin or its longer acting synthetic analogue, Octreotide, has been utilized in the treatment of congenital chylothorax. Herein, we report a case of congenital chylothorax in which resolution was aided with Octreotide. Our case is a female born at term to a 45 year old mother, diagnosed to have trisomy 21 with atrioventricular canal defects, managed with antifailure medications, exclusively breast fed, and at 35days of life developed tachypnea with desaturation. Chest xray showed moderate size right pleural effusion fig 1. A chest drain was inserted and managed per NICU protocol fig 2. In view of the usual conservative management, still the chylothorax remained there, Octreotide was commenced on day 3, and treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage over 6days fig 3.