| Association between surgical repair timing and mortality in neonates with congenital diaphragmatic hernia: a systematic review and meta-analysis |
Veerabhadra Radhakrishna1 
, Bharathi Balachander2
, Sanjana Hansoge Somanath3
, Hejmady Aneesh Shenoy4
, Srinivas Balachander5
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1Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, India
2Department of Neonatology, St. John’s Medical College Hospital, Bengaluru, India
3Department of Neonatology, All India Institute of Medical Sciences (Nagpur), Nagpur, India
4Department of Pediatric Surgery, Rajarajeswari Medical College and Hospital, Bengaluru, India
5Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India |
Correspondence:
Veerabhadra Radhakrishna, Email: vbrps2016@gmail.com
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Received: 30 June 2026 • Revised: 3 August 2026 • Accepted: 10 August 2026 |
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| Abstract |
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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. |
| Key Words:
Congenital diaphragmatic hernia, Mortality, Surgical repair, Time-to-treatment, Extracorporeal membrane oxygenation |
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