Purpose Townsville University Hospital is the only paediatric surgery centre in North Queensland (catchment area of 750, 000 square km). Our centre has a neonatal intensive care, paediatric surgeons, paediatric anaesthetists but does not have ECMO. In 2013, a retrospective study evaluating the survival of neonates with congenital diaphragmatic hernia (CDH) at our centre was published. We have performed this follow up study to assess changes in management, survival and outcomes over the past decade. Methodology Retrospective study of neonates managed at Townsville University Hospital with CDH. Data compared from two groups: 1987-2010 and 2011-2023. Results A total of 74 neonates with CDH were managed during the period, n=52 from 1987-2010 and n=22 from 2011-2023. The antenatal detection of CDH improved from 54% (n=28/52) to 77% (n=17/22). This was associated with more mothers giving birth in Townsville (n=30/52 versus n=19/22). There was no significant change in birth weight (mean 2949 vs 3136) or gestational age (mean 38 in both groups). Time to surgery post birth has increased over the study period from a median of 36 hours in 1987-2010 to 67 hours in 2010-2023. From 2011-2023, two neonates were transferred to Queensland Children’s Hospital for ECMO and four neonates required repeat operation for a recurrence. The survival over the time period initially increased and now is stable: 67% from 1987-2002 (n=35/52), 86% from 2003-2010 (n=13/15) and 86% from 2011-2023 (n=19/22). Conclusion There has been an increase in the antenatal detection of CDH in our population. Significant improvement in mortality was seen from 1987 to 2010, which has now plateaued over the past decade.