Despite advances in neonatal care including prenatal diagnosis, conventional ventilation, surfactant, high frequency oscillation, nitric oxide and extracorporeal membrane oxygenation (ECMO) the diagnosis of CDH is reported to carry a high mortality rate. Pulmonary hypoplasia and persistent pulmonary hypertension are major factors that contribute to death. In an effort to improve the survival of these infants a protocolized approach was adopted. In summary, this involves antenatal use of steroids if CDH antenatally diagnosed, sedation and muscle relaxation following tracheal intubation, administration of surfactant, gentle ventilation with permissive hypercapnia, trial of nitric oxide, preoperative ECMO for those infants failing therapy and delayed repair of the CDH. With the use of this protocolized approach the survival of infants with isolated CDH was 96 % for inborn and 81 % for outborn infants.