A term neonate develops severe respiratory distress within minutes of birth. The abdomen is scaphoid and bowel sounds are audible over the left hemithorax. Chest X-ray shows multiple air-filled loops in the left chest with the mediastinum shifted to the right. Which immediate step is contraindicated?
- A Bag-and-mask positive pressure ventilation ✓
- B Endotracheal intubation and mechanical ventilation
- C Insertion of a nasogastric tube with continuous suction
- D Placement of an arterial line for preductal and postductal monitoring
Correct answer: A. Bag-and-mask positive pressure ventilation
Explanation
In congenital diaphragmatic hernia, bag-and-mask ventilation forces gas into the stomach and intestines, distending intrathoracic viscera and worsening mediastinal shift and hypoxia. The correct initial steps are nasogastric decompression, endotracheal intubation, and gentle ventilation strategies that limit barotrauma. The scaphoid abdomen with thoracic bowel loops distinguishes this from simple surfactant deficiency, where mask ventilation would be appropriate.
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.