What is an important first step in resuscitating a newborn with severe congenital diaphragmatic hernia?

In the management of a newborn with severe congenital diaphragmatic hernia (CDH), intubation and the insertion of an orogastric tube is a crucial first step. This is because CDH often leads to significant respiratory distress due to the displacement of the lungs and associated structures, which can hinder effective breathing.

Intubation is essential as it secures the airway and facilitates controlled ventilation, allowing for proper oxygenation and carbon dioxide removal. Given that these infants commonly experience significant respiratory failure, ensuring effective ventilation is critical. The orogastric tube is used to decompress the stomach, which can help to decrease pressure in the thoracic cavity and improve lung function. This step can relieve any associated abdominal distension that may further compromise respiratory mechanics.

Starting chest compressions or providing positive pressure ventilation without securing the airway first could lead to ineffective resuscitation and increased risk of further complicating the situation. Monitoring heart rates, while important, is secondary to ensuring that the infant is breathing effectively and that the airway is clear to allow for proper physiological functioning. Focusing on intubation and decompression directly addresses the life-threatening issues presented by severe CDH.