A newborn develops severe respiratory distress within minutes of birth with scaphoid abdomen and absent breath sounds on the left. Chest X-ray shows bowel loops in the left hemithorax with mediastinal shift to the right. Which immediate step is contraindicated?

• A Insertion of a nasogastric tube connected to continuous suction
• B Endotracheal intubation and mechanical ventilation
• C Placement of arterial line for preductal saturation monitoring
• D Bag-and-mask positive pressure ventilation ✓

Explanation

This is a left congenital diaphragmatic hernia (Bochdalek). Bag-and-mask ventilation forces air into the stomach and intestines lying in the chest, worsening compression of the lungs and mediastinal shift, so it is contraindicated. Initial management is nasogastric decompression, endotracheal intubation, and gentle ventilation aiming for permissive hypercapnia. The defect is usually a left posterolateral one, which explains the scaphoid abdomen and left-sided findings.

Reference: Ashcraft's Pediatric Surgery, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.