What should be avoided during the resuscitation of a baby with congenital diaphragmatic hernia?

During the resuscitation of a baby with congenital diaphragmatic hernia, manual ventilation with a face mask should be avoided because it can lead to further inflation of the stomach and compromise ventilation. This condition often results in the presence of herniated abdominal contents into the thoracic cavity, which can already impair lung function. When a face mask is used for manual ventilation, any air that is forced into the lungs can inadvertently inflate the stomach, worsening respiratory distress and potentially leading to a mediastinal shift.

In contrast, assessing airway patency is a crucial step in any resuscitation and should always be carried out. Similarly, using a bag-mask device is an acceptable method of providing positive pressure ventilation; however, special caution should be exercised to avoid overzealous ventilation. Oxygen supplementation is also important and often necessary in the resuscitation of newborns, especially those with conditions that compromise oxygenation, such as congenital diaphragmatic hernia. Therefore, the avoidance of manual ventilation with a face mask is based on the need to minimize complications that could further hinder respiratory function.