THAT congenital diaphragmatic hernia in infancy may in a period of minutes become an urgent surgical emergency was recently brought to our attention. We were dealing with a 2 month old infant with diaphragmatic hernia, who, when first seen by the surgical staff, presented only mild symptoms of respiratory, cardiac and gastrointestinal embarrassment, with spells of dyspnea, cyanosis and vomiting. Within three hours the child became markedly cyanotic and dyspneic and required immediate surgical intervention. We were strongly impressed by Harrington's statement1 when he said: "Many infants born with these congenital hernias die in the first few hours or days of life due to respiratory and cardiac embarrassment before surgical intervention can be instituted." This "near miss" encountered on our service at the Los Angeles County Hospital prompted us to review the cases of congenital diaphragmatic hernia occurring during the first year of life at that institution in the