An infant presents in the delivery room with a scaphoid abdomen and signs of respiratory distress. Which must be suspected?

• A. Congenital diaphragmatic hernia (CDH)
• B. Eventration of the diaphragm
• C. Intestinal obstruction
• D. Pneumothorax

Answer: (A)

When a newborn presents with a sunken, scaphoid abdomen and breathing difficulties, think congenital diaphragmatic hernia. The diaphragmatic defect lets abdominal organs move into the chest, so the abdomen appears hollow because the contents are no longer there to fill it. This intrathoracic displacement markedly reduces fetal and after-birth lung development, leading to pulmonary hypoplasia and distress as the baby tries to ventilate with less functioning lung tissue. Left-sided CDH is the common pattern, so you may hear decreased breath sounds on the affected side and see bowel loops or air in the chest on imaging, with a relatively quiet abdomen due to displaced contents. This combination of findings is much more characteristic of CDH than the other possibilities, which do not usually produce a scaphoid abdomen paired with respiratory failure in the delivery room.