A term newborn develops severe respiratory distress within minutes of birth. The abdomen is scaphoid, breath sounds are absent on the left, and heart sounds are displaced to the right. Chest X-ray shows multiple air-filled loops in the left hemithorax. The single most appropriate immediate step is:

• A Endotracheal intubation with nasogastric decompression ✓
• B Bag and mask ventilation with high flow oxygen
• C Immediate thoracotomy to reduce the hernia
• D Needle thoracostomy of the left chest

Explanation

This is a left posterolateral Bochdalek congenital diaphragmatic hernia. The immediate priority is endotracheal intubation with nasogastric decompression to prevent gaseous distension of intrathoracic bowel. Bag and mask ventilation is contraindicated because forced positive pressure inflates the stomach and bowel inside the chest, worsening mediastinal shift and respiratory compromise. Surgery follows only after stabilisation, because mortality depends on the degree of pulmonary hypoplasia and persistent pulmonary hypertension, not on the speed of operative reduction.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.