B

Pulmonary hypertension is a major driver of mortality, large diaphragm defects markedly lower survival, and an earlier prenatal diagnosis (low gestational age) correlates with more severe pulmonary hypoplasia and worse outcome [Wynn 2013, PMID 23375362; Lally 2007, PMID 17766505; Bouchghoul 2015, PMID 26070705]. In contrast, multiple randomized trials and systematic reviews show that whether CDH is repaired immediately or after a period of stabilization does not independently change survival, making delay in emergent surgery the least important prognostic variable [Moyer 2002 Cochrane Review, PMID 12137629].