Air transport of the neonate with a congenital diaphragmatic hernia

A congenital diaphragmatic hernia is the prenatal herniation of abdominal contents into the chest cavity; the infant usually has a hypoplastic lung on the side of the hernia. The neonate presents with cyanosis, tachypnea, retractions, and a scaphoid abdomen. A simple chest X-ray will confirm the diagnosis by revealing hollow viscera in the chest cavity. Survival is dependent upon rapid transport to a major surgical center equipped to perform the necessary surgery and provide the post-operative care. The newborn should be kept warm, well oxygenated, and normocapneic to avoid acidosis. Acidosis could result in reversal to fetal circulation, rapid deterioration, and death. Should we be called upon to transport a neonate with a congenital diaphragmatic hernia we must realize the severity of this anomaly and be prepared to prevent, recognize, and/or treat any life-threatening emergencies that occur.