Congenital chylothorax is rare in preterm infants. While most cases respond to conservative treatment, a few require surgery. Treatment with intravenous octreotide has been reported to have varying success in preterm infants. A fetus was diagnosed with bilateral hydrothoraces at 29 weeks of gestation and repeated thoracocentesis was performed antenatally to allow growth of the lungs. She was delivered electively at 32 weeks by caesarean section. Hydrops fetalis was confirmed and chest tubes were inserted bilaterally soon after birth. Intravenous octreotide was commenced on day 4 of life, titrated to a maximum of 10 μg/kg/hr for a total of 28 days. Hydrothorax resolved at day 30 and total parenteral nutrition was given for a total of 37 days. She was successfully extubated on day 40 of life and discharged on day 80. On review at 6 months of age, she was thriving and developing normally.