Association between surgical repair timing and mortality in neonates with congenital diaphragmatic hernia: a systematic review and meta-analysis.

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly whose management involves a complex interplay between medical and surgical treatments. Stabilization prior to surgery is vital. However, the optimal timing of surgical repair and its relationship with mortality remain unknown. Hence, this meta-analysis aimed to evaluate the association between repair timing and mortality in neonates with CDH. A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The PubMed, NCBI, Cochrane CENTRAL, Google Scholar, CINHAL, Ovid, Scopus, Web of Science, and Epistemonikos databases were searched for articles published through April 2026. Forty studies, including 2 randomized controlled trials, 3 prospective observational studies, and 35 retrospective studies, were included in the meta-analysis. Newborns operated on within 24 hours of life had significantly higher mortality (relative risk [RR], 2.54; 95% confidence interval [CI], 1.76-3.66; P<0.001) than those operated on at or after 24 hours. This association persisted in a subgroup analysis restricted to contemporary studies published since 2000 (RR, 2.57; 95% CI, 1.00-6.62; P<0.001). Additional subgroup analyses demonstrated significantly higher mortality in neonates who underwent repair within 24 hours than in those who underwent repair at 24-48 hours (P<0.001), whereas mortality did not differ significantly between those who underwent repair at 24-48 hours and those who underwent repair after 48 hours (P=0.65). Surgical timing did not significantly alter mortality in a specific subset of newborns requiring ECMO support. In conclusion, a brief period of stabilization of at least 24 hours significantly improved survival among neonates with CDH, whereas delaying surgical repair beyond 48 hours conferred no additional survival benefits.