Clinical stabilization in the surgical management of neonatal congenital diaphragmatic hernia: survival and morbidity compared to immediate repair

Abstract

Congenital diaphragmatic hernia (CDH) is one of the most severe neonatal malformations, associated with high mortality and significant functional morbidity. This study consists of a systematic review of recent literature on the surgical management of CDH in newborns, focusing on the impact of repair after clinical stabilization compared with immediate surgery. Studies published between 2021 and 2025 were analyzed, addressing surgical criteria, operative techniques, centralization of care, prognosis, and morbidity. The results demonstrate that individualized surgical timing, based on physiological stabilization and multidisciplinary coordination, reduces perioperative complications and significantly improves outcomes, particularly in referral centers. Primary repair remains the preferred approach for small or moderate defects, whereas the use of patches and fetal therapies requires selective indication. Despite advances in survival, long-term morbidity persists, demanding structured multidisciplinary follow-up and public policies to ensure universal access to specialized care and rehabilitation. The future of CDH management requires the integration of technological innovation, personalized medicine, and equitable access, consolidating the importance of standardized protocols and strengthening reference networks to achieve definitive reduction of disparities.