A full-term male neonate develops severe respiratory distress within minutes of birth. Examination reveals a scaphoid abdomen and absent breath sounds on the left, with heart sounds shifted to the right. Chest X-ray shows multiple air-filled bowel loops in the left hemithorax. What is the most appropriate immediate management?

• A Emergency surgical repair of the diaphragmatic defect
• B Bag-and-mask ventilation with high-flow oxygen
• C Immediate pleural drainage with an intercostal drain
• D Endotracheal intubation with nasogastric decompression ✓

Explanation

This is a left-sided congenital diaphragmatic hernia (Bochdalek). The priority is stabilisation, not surgery: intubate early and pass a nasogastric tube to decompress the herniated gut. Bag-and-mask ventilation is specifically harmful because it forces gas into the stomach and intestines, distending intrathoracic bowel and worsening compression of the lungs and mediastinum. An intercostal drain is wrong because the lucencies are bowel loops, not a pneumothorax.

Reference: Ashcraft's Pediatric Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.