This newborn exhibits cyanosis, tachypnea, absent breath sounds on the left, heart sounds shifted further to the right, and a scaphoid abdomen. These features, together with the chest x-ray demonstrating a mediastinal shift to the right, bowel loops within the thoracic cavity, and a poorly aerated lung in the left hemithorax, confirm the diagnosis of a congenital diaphragmatic hernia (CDH).
In patients with congenital diaphragmatic hernia, the compression of the lung from protruded abdominal contents may interfere with fetal lung maturation and lead to pulmonary hypoplasia, persistent pulmonary hypertension, and poor surfactant production, resulting in severe respiratory distress of the newborn. Intubation and mechanical ventilation are the priority in all patients with CDH and should be performed prior to any further intervention, because they help to decrease air swallowing and correct hypoxia. As in this patient, the majority (approx. 85%) of CDH cases are left-sided.