Objective: To examine national trends in bivalirudin use among neonates with congenital diaphragmatic hernia (CDH) supported with extracorporeal membrane oxygenation (ECMO) and to evaluate its association with mortality and morbidity. Summary Background Data: Preliminary data suggest that first-line anticoagulation of the ECMO circuit with bivalirudin, a direct thrombin inhibitor, may improve outcomes in neonates with CDH. Methods: This multicenter retrospective cohort study used data from 48 Un