Operative management of a newborn with the chest X-ray shown in Fig. below
should occur:a. Immediately after birth
The diagnosis of congenital diaphragmatic hernia (CDH) is made by chest X-ray, with the vast majority of infants developing immediate respiratory distress and pulmonary hypertension. CDH care has improved considerably through effective use of improved methods of ventilation and timely cannulation for extracorporeal membrane oxygenation. In the past, correction of the hernia was believed to be a surgical emergency, and patients underwent surgery shortly after birth. It is now accepted that the presence of persistent pulmonary hypertension that results in right-to-left shunting across the patent foramen ovale or the ductus arteriosus and the degree of pulmonary hypoplasia are the leading causes of cardiorespiratory insufficiency. Current management therefore is directed toward managing the pulmonary hypertension, which is usually seen within 7 to 10 days, but in some infants, may take up to several weeks.