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Congenital diaphragmatic hernia — MRCPCH FOP MCQ

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HardNeonatologyCongenital diaphragmatic herniaMRCPCH FOP

A term newborn has severe respiratory distress, a scaphoid abdomen and reduced breath sounds on the left. Chest radiograph shows bowel gas within the left hemithorax and mediastinal shift. What is the most likely diagnosis?

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Correct answer: A — Congenital diaphragmatic hernia

Severe respiratory distress, scaphoid abdomen, unilateral reduced breath sounds and bowel gas in the chest are diagnostic of congenital diaphragmatic hernia. Meconium aspiration gives patchy pulmonary infiltrates rather than bowel loops in the hemithorax. Respiratory distress syndrome is mainly a preterm surfactant problem with low-volume lungs. The pearl is that bag-mask ventilation can worsen bowel distension in the chest.

Reference: NLS/Resuscitation Council UK; BAPM neonatal stabilisation guidance