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Persisting Motor Function Problems in School-Aged Survivors of Congenital Diaphragmatic Hernia
Sophie de Munck1, Monique H M van der Cammen-van Zijp1, Tabitha P L Zanen-van den Adel2
1Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands.
Insights
Children born with congenital diaphragmatic hernia (CDH) face persistent motor function impairment, especially those treated with extracorporeal membrane oxygenation (ECMO). Long-term follow-up is crucial for these children to manage developmental challenges.
Area of Science:
- Pediatric Medicine
- Developmental Pediatrics
- Neonatology
Background:
- Congenital diaphragmatic hernia (CDH) poses risks for childhood motor function impairment.
- Extracorporeal membrane oxygenation (ECMO) is a treatment for severe CDH, but its long-term effects on motor development are a concern.
- This study investigates persistent motor function deficits in children with CDH, hypothesizing that impairment occurs regardless of ECMO treatment.
Purpose of the Study:
- To longitudinally assess motor function in children with CDH.
- To compare motor outcomes between children with CDH who received ECMO treatment and those who did not.
- To identify factors associated with motor function impairment in CDH survivors.
Main Methods:
- A prospective follow-up study included children with CDH born between 1999-2007.
- Motor function was assessed using the Movement Assessment Battery for Children (M-ABC) at ages 5, 8, and 12 years.
- Longitudinal analysis employed general linear models with M-ABC z-scores.
Main Results:
- Of 55 included children, 25 received ECMO; 78% were evaluated at all three time points.
- Overall mean M-ABC z-scores indicated motor function below norm at 5, 8, and 12 years (-0.67, -0.35, -0.46 respectively).
- Children treated with ECMO showed significantly lower motor scores at all ages compared to non-ECMO treated children, particularly at age 5. Longer hospital stay correlated with poorer motor outcomes.
Conclusions:
- Children with CDH are at risk for persistent motor function impairment throughout school age.
- Motor deficits are more pronounced and persistent in children with CDH who underwent ECMO treatment.
- Long-term, specialized follow-up is recommended for children with CDH, especially those treated with ECMO, to address motor development challenges.
Abstract:
Background and Objectives: Children born with congenital diaphragmatic hernia (CDH) and treated with extracorporeal membrane oxygenation (ECMO), are at risk for motor function impairment during childhood. We hypothesized that all children born with CDH are at risk for persistent motor function impairment, irrespective of ECMO-treatment. We longitudinally assessed these children's motor function. Methods: Children with CDH with and without ECMO-treatment, born 1999-2007, who joined our structural prospective follow-up program were assessed with the Movement Assessment Battery for Children (M-ABC) at 5, 8, 12 years. Z-scores were used in a general linear model for longitudinal analysis. Results: We included 55 children, of whom 25 had been treated with ECMO. Forty-three (78%) were evaluated at three ages. Estimated mean (95% CI) z-scores from the general linear model were -0.67 (-0.96 to -0.39) at 5 years of age, -0.35 (-0.65 to -0.05) at 8 years, and -0.46 (-0.76 to -0.17) at 12 years. The 5- and 8-years scores differed significantly (p = 0.02). Motor development was significantly below the norm in non-ECMO treated patients at five years; -0.44 (-0.83 to -0.05), and at all ages in the ECMO-treated-patients: -0.90 (-1.32 to -0.49), -0.45 (-0.90 to -0.02) and -0.75 (-1.2 to -0.34) at 5, 8, and 12 years, respectively. Length of hospital stay was negatively associated with estimated total z-score M-ABC (p = 0.004 multivariate analysis). Conclusion: School-age children born with CDH are at risk for motor function impairment, which persists in those who received ECMO-treatment. Especially for them long-term follow up is recommended.
