Between intubation attempts, bag-mask ventilation should be used to stabilize the infant unless which condition is suspected?

• A. Congenital diaphragmatic hernia
• B. Sepsis
• C. Hypoxia
• D. Pneumothorax

Answer: (A)

Bag-mask ventilation is used between intubation attempts to maintain oxygenation and prevent hypoxemia. If a congenital diaphragmatic hernia is suspected, this approach should be avoided because air pushed in with a bag-mask can inflate the stomach and intestines, worsening gastric distension and compressing the already underdeveloped lungs. This makes ventilation more difficult and can aggravate pulmonary hypertension. The preferred management is rapid endotracheal intubation with controlled ventilation, often paired with gastric decompression to relieve abdominal contents from the thoracic cavity and improve lung mechanics. Sepsis or hypoxia do not by themselves require skipping bag-mask ventilation, whereas a suspected pneumothorax would prompt a different approach to avoid worsening the air leak with positive pressure.