What is the recommended management of a neonate with Congenital Diaphragmatic Hernia (CDH) regarding ventilation?

In the management of a neonate with Congenital Diaphragmatic Hernia (CDH), the avoidance of bag/mask ventilation is crucial. While bag/mask ventilation might be used in some neonatal emergencies, it can exacerbate the respiratory distress seen in infants with CDH. This is because bag/mask ventilation can inflate the stomach due to air entry, potentially worsening the herniation and displacing the mediastinal structures, which could further compromise lung function.

In CDH, the primary concern is often significant lung hypoplasia and impaired gas exchange due to the dislocation of vital structures. Therefore, it is critical to minimize respiratory complications and manage ventilation in a way that does not increase intrathoracic pressure. Typically, strategies such as intubation are preferred initially to ensure controlled ventilation and to facilitate adequate lung expansion.

Intubation allows for direct control of ventilation and prevents further inflation of the stomach, which helps in managing the infant's overall respiratory status more effectively. Consequently, when managing a neonate with CDH, focusing on techniques that provide stable and controlled ventilation while avoiding methods that could increase pressure in the thoracic cavity is essential.