Aim: To evaluate long-term respiratory outcomes and identify factors associated with persistent respiratory symptoms (PRS) in patients who have undergone surgery for congenital diaphragmatic hernia (CDH). Methods: This retrospective study included 129 surviving patients with CDH who underwent surgical repair at a tertiary referral center between 2017 and 2025.Demographic, perinatal, surgical, and clinical data were collected.PRS were defined as wheezing, recurrent lower respiratory tract infections, chronic cough, need for supplemental oxygen at discharge, and/or FEV₁ <80% predicted during post-discharge follow-up. Results: Median age was 53 days, and median follow-up was 39.5 months. PRS were identified in 32.0% of patients(Figure-1).PRS were significantly associated with recurrent hospitalizations, thoracotomy, chronic radiographic changes, and the need for supplemental oxygen (p<0.05).Recurrent hospitalization was the strongest independent predictor of PRS (OR:21.3, 95% CI:3.6–126.5; p<0.001(Figure-2). Conclusion: Approximately one-third of patients with CHD have persistent respiratory symptoms, and recurrent hospitalizations are the main risk factor for PRS. erj;68/suppl_70/PA1732/F1 F1 F1 erj;68/suppl_70/PA1732/F2 F2 F2