A term neonate develops severe respiratory distress within minutes of birth. The scrotum is empty, breath sounds are absent on the left, heart sounds are shifted to the right, and the abdomen appears scaphoid. Chest X-ray shows multiple air-filled loops of bowel in the left hemithorax. What is the correct initial management?

• A Immediate surgical repair of the diaphragmatic defect
• B Bag and mask positive pressure ventilation followed by urgent thoracotomy
• C Endotracheal intubation, nasogastric decompression, gentle ventilation strategies, and delayed surgical repair once stabilized ✓
• D Immediate extracorporeal membrane oxygenation before any other intervention

Explanation

Congenital diaphragmatic hernia causes pulmonary hypoplasia and persistent pulmonary hypertension, so the priority is physiological stabilization rather than immediate operation. Intubation avoids gavage of air into stomach and bowel, nasogastric decompression reduces intrathoracic visceral volume, and permissive hypercapnia with gentle ventilation limits barotrauma. Repair is undertaken once oxygenation stabilizes. Bag and mask ventilation, option B, distends the intrathoracic gut and worsens compression, and is specifically avoided.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.