not-yet-known not-yet-known not-yet-known unknown Rationale: Neonates with congenital diaphragmatic hernia (CDH) frequently experience central airway abnormalities, including tracheobronchomalacia, which persist post-surgical repair. However, these complications often remain underdiagnosed due to reliance on symptomatic evaluation and limited use of bronchoscopy. Ultrashort echo time (UTE) magnetic resonance imaging (MRI) offers a non-invasive, three-dimensional method to assess airway dynamics and evaluate tracheobronchomalacia. Objectives: To quantify changes in central airway morphology and dynamics before and after surgical diaphragmatic repair in neonates with CDH using UTE MRI. Methods: This study examined neonates with CDH admitted between 2015-2020 who underwent both pre- and post-surgical UTE MRI. Airway dynamics were assessed using respiratory-gated radial three-dimensional UTE images at four breathing phases. Three-dimensional airway surfaces were generated from the cricoid to the main bronchi. Changes from pre- to post-surgery in cross-sectional areas, dynamic collapse, and eccentricity index were analyzed. Results: Six neonates with left-sided CDH were included. Following surgery, tracheal minimum eccentricity index at end expiration decreased significantly (0.68±0.06 to 0.53±0.15, p=0.023), indicating increased collapse. The ipsilateral bronchus demonstrated similar changes, with eccentricity index decreasing significantly from 0.65±0.04 to 0.55±0.11 (p=0.048), while the contralateral bronchus remained stable. Mean tracheal cross-sectional area decreased from 22.7±6.1 mm 2 to 19.1±3.1 mm 2 (p=0.115), while dynamic motion increased from 21±7% to 40±15% (p=0.055). Conclusions: Neonates with CDH have significant central airway abnormalities pre-surgery, which persists and may worsen post-repair, particularly in the trachea and ipsilateral bronchus. These findings suggest tracheobronchomalacia is an underrecognized component of CDH. Integrating airway assessment into surgical planning could improve post-operative outcomes.