What is the role of echocardiography in newborns with CDH?

Congenital diaphragmatic hernia (CDH) is associated with high neonatal morbidity and mortality, often due to complex cardiovascular physiology and ventricular dysfunction. Echocardiography is a critical tool for assessing cardiac anatomy, ventricular performance, pulmonary hypertension, and shunt dynamics in both the prenatal and postnatal periods. Early echocardiographic evaluation can identify high-risk physiologic phenotypes and guide targeted interventions, yet optimal timing and frequency remain uncertain. This review outlines the role of fetal and neonatal echocardiography in CDH, highlights view-specific imaging strategies, and discusses key physiologic patterns. While early imaging may inform management, it must be interpreted in context to avoid unnecessary interventions. A targeted, phenotype-driven approach to echocardiography can support individualized care. Further research is needed to establish standardized protocols and determine the impact of echocardiographic timing on outcomes in this vulnerable population.