Congenital diaphragmatic hernia (CDH) is a complex neonatal condition characterized by pulmonary hypoplasia and pulmonary hypertension, requiring specialized ventilatory management from birth through postoperative care. This article synthesizes the current evidences and evolving strategies for optimizing respiratory support in CDH, emphasizing the importance of gentle ventilation to minimize lung injury and improve outcomes. We discuss delivery room resuscitation protocols, initial ventilator settings, and the comparative roles of conventional mechanical ventilation and high-frequency ventilation. Despite advances, significant variability persists in practice, underscoring the need for high-quality clinical trials to refine evidence-based guidelines and reduce morbidity and mortality in this vulnerable population.