Congenital diaphragmatic hernia is a rare but potentially fatal condition in which abdominal organs herniate into the thoracic cavity, leading to pulmonary hypoplasia and respiratory distress. Interinstitutional variability exists for disease management, and in this study, we present evidence-based recommendations regarding delivery room management, respiratory, hemodynamic, and nutritional support, sedation, and vascular access. Adequate preoperative management is essential for stabilizing these neonates before surgical correction, aiming to improve pulmonary function and overall neonatal well-being. In the present manuscript, we detail the preoperative approach employed by Texas Children's Hospital to manage congenital diaphragmatic hernia.