Classical case of Congenital Diaphragmatic Hernia

A Single/ Term Male Baby weighing 3.0 kg was delivered via emergency LSCS for fetal distress who was prenatally diagnosed to have congenital diaphragmatic hernia in utero. He was born with Apgar score 4/10, 6/10, was immediately intubated and transferred to NICU. After stabilizing was put under ventilator and planned for Operation by Pediatric surgery team.
Chest Xray –
Showed B/L severe pulmonary hypoplasia with Intestinal content in the lt chest with displacement of the mediastinum to right.

Almost entire bowel loops were in the chest.

Initial Stabilization till Intubation can be done-
1. Oxygen by blow-by and insert 10 F Orogastric tube. Remove air manually by aspiration.
2.Attach the OG tube to an intermittent suction device set at 40 mmHg pressure or do frequent manual aspirations.
3.Get a Chest Xray and be sure gastric tube is in place. Locate the stomach.
4. Make sure of adequate oxygenation to prevent PPHN
5.Evlauate for PPHN with preductal and post ductal saturation measurements.
6.Maintain adequate hydration and if needed – Inotropic support.
7.Watch closely for Pneumothorax.
8.Keep the infant calm with anagesia.

In such Scenario-
1. Bag and Mask Ventilation is contraindicated as it inflates the gut and further compromising the lung functions
2. Intubation and Bagging should be done and NG should be inserted.
Intuabtion is preferred with cuffed ET tube.

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