Congenital diaphragmatic hernia presents the paediatric surgeon with one of the most exciting challanges. Early diagnosis is essential and the value apparent dextrocardia seen in infants with hernia on the left side is stressed. Early chest Xray is necessary to confirm the diagnosis. Treatment must prevent hypoxic damage until the anomaly is corrected. Apart from useful laboratory tests, fine judgement of the ventilatory state of the patient is necessary. Over-treatment is probably as dangerous as under-treatment. The lung hypoplasia which is marked in the severe cases of diaphragmatic hernia gives rise to problems in management. Bilateral intercostal drains are advised to prevent the danger of contralateral pneumothorax in the infants operated on within 24 hours of birth. Few infants die of hypoplasia of the lungs per se and only when complications such as infection or pneumothorax occur does the critical level of functioning lung tissue fall below that required for survival. Mortality of the infant with cardio-respiratory distress from congenital diaphragmatic hernia is currently around 50% in the first 24 hours of life but is very low, less than 5% thereafter. It can be further reduced by prompt diagnosis and treatment. This includes diagnosis of associated abnormalities such as preductal coarctation and patent ductus arteriosus with operative correction of the associated anomalies as well as the primary diaphragmatic defect.

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