Clinical context (Respiratory distress at birth, scaphoid abdomen, shifted heart sounds, barrel chest — pulmonary hypoplasia and pulmonary hypertension; intubate early, avoid bag-mask overdistension, NG decompression, minimal stimulation, ECMO-capable center transfer)
First-line therapy
Early intubation + avoid bag-mask ventilation + NG + gentle ventilation + urgent ECMO-capable transfer • —
Duration: Until transfer / definitive care · ABCDE; immediate intubation preferred over bag-mask (gastric/intestinal distension worsens ventilation); large-bore NG on continuous suction; gentle ventilation targeting preductal SpO₂ 85–95% per NICU protocol; minimal handling/stimulation; IV access; avoid high peak pressures; urgent transfer to surgical NICU with ECMO
Supportive care — antibiotics only if infection suspected • —
Duration: Preoperative · Routine prophylactic antibiotics not standard for CDH — ampicillin + gentamicin if suspected sepsis or pneumonia (APSA, CDH EURO consortium principles)
Clinical notes
• Recognition: immediate respiratory distress, scaphoid (concave) abdomen, decreased breath sounds on affected side, mediastinal shift, bowel loops in chest on CXR.
• Critical: avoid vigorous bag-mask ventilation — insufflated air enters bowel in chest and worsens lung compression; intubate early with OG/NG decompression.
• Pulmonary hypertension management at receiving center — iNO, ECMO; surgery timing delayed until stabilized (modern gentle ventilation strategies).
• Do NOT: bag-mask vigorously, give oral feeds, delay transfer for non-essential studies if unstable.
• High mortality without specialized center — communicate diagnosis and interventions on transfer.
• APSA — Congenital diaphragmatic hernia (2024)
• AAP — CDH initial management (2024)
• CDH EURO Consortium — Stabilization principles (2023)
+ 1 more
• WHO Pocket Book — Severe respiratory distress in newborns (2022)
