There is an emerging consensus that the surgical repair for congenital diaphragmatic hernia is best done:

c. When the infant is potentially extubatable

Infants with diaphragmatic hernias have considerable variation in the degree of respiratory distress, and the degree of distress dictates timing of repair. Traditionally, infants were rushed emergently to the operating room for reduction of the herniated viscera and diaphragmatic closure. Because effective preoperative decompression of the intestine is usually possible and because it has become clear that the underlying pulmonary hypoplasia is not reversed by emergency operation, this sense of urgency is no longer accepted. Most surgeons now commit themselves to a period of preoperative stabilization which is used to confirm the diagnosis and optimize medical care. The current recommendation is that operative repair be undertaken in a stable patient who is nearing extubatable levels of ventilatory support, regardless of the means of support which have been employed. This means that repair is done at or after the end of cardiopulmonary bypass in infants where that is necessary. The results with a delayed approach appear at least equivalent and in several series better than with emergent or early repair. The concept is that the deferral of the iatrogenic operative injury to a time when the neonatal pulmonary vascular bed is less vulnerable to vasospasm is desirable.