Clinical history indicate towards congenital diaphragmatic hernia because physical examination reveals an unusually flat stomach when the newborn is lying down; auscultation demonstrates no breath sounds on the left side of the thorax Congenital diaphragmatic hernia is a defect in the diaphragm. An absent or paially formed diaphragm results in an abnormal opening (hernia) that allows the stomach and intestines to move into the chest cavity and crowd the hea and lungs. This crowding can lead to underdevelopment of the lungs (pulmonary hypoplasia), potentially resulting in life-threatening breathing difficulties that are apparent from bih. Loss of breath and cyanosis result from pulmonary hypoplasia associated with congenital diaphragmatic hernia. Placing the baby in an upright position will reduce the hernia somewhat and ease the pressure on the lungs, thereby increasing the baby's comfo. The baby's stomach is flat (instead of the plump belly of a normal newborn) because the abdominal viscera have herniated into the thorax. Auscultation reveals no breath sounds on the left side because of pulmonary hypoplasia. TOF also presents with cyanosis but pt. improves in squatting position not in upright position. Physiological umbilical herniation-is a self limiting condition not associated with cyanosis.