An infant diagnosed prenatally with a diaphragmatic hernia. Care immediately after delivery should include which of the following?

• A. Placement of an orogastric tube
• B. Initiation of mask ventilation for respiratory support
• C. Immediate surfactant administration
• D. Immediate chest tube insertion

Answer: (A)

In congenital diaphragmatic hernia, abdominal organs herniate into the chest, severely limiting lung expansion and predisposing the infant to respiratory distress and pulmonary hypertension. The immediate priority after birth is to relieve intrathoracic crowding and improve ventilation. Placing an orogastric tube to decompress the stomach is essential because a distended stomach within the chest further compresses the lungs, worsens oxygenation, and can increase the risk of aspiration. By emptying the stomach, you reduce lung compression and help stabilize gas exchange while preparing for definitive surgical repair.

Avoiding mask ventilation is important because it can push air into the stomach and worsen distention, making respiratory effort even more difficult. Surfactant administration isn’t the first action here, since the primary problem is mechanical compression rather than surfactant deficiency, though it could be considered later if lung mechanics remain poor. Chest tube insertion is not routinely required at birth and is reserved for specific complications such as a pneumothorax.