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CDH Ventilation Strategy — RACP Paediatrics MCQ

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HardRespiratoryCDH Ventilation StrategyRACP Paediatrics

A newborn is assessed for risk of congenital diaphragmatic hernia. Prenatal ultrasound shows herniation of abdominal contents into the left chest with mediastinal shift. What initial ventilation strategy is recommended at birth?

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Correct answer: E — Immediate intubation with gentle ventilation (low PIP, permissive hypercapnia)

CDH management prioritises gentle ventilation to avoid barotrauma and worsening pulmonary hypertension. Immediate intubation, avoidance of bag-mask ventilation (which distends the herniated bowel), low peak inspiratory pressures, and permissive hypercapnia are key principles.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Congenital Diaphragmatic Hernia