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Motor and functional characteristics in school-age survivors of congenital diaphragmatic hernia: a cross-sectional
Takamasa Mitsumatsu1, Yuji Ito2, Yukako Muramatsu3
1Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
School-age survivors of congenital diaphragmatic hernia (CDH) often have impaired motor function, including reduced grip strength and balance. Early intervention focusing on muscle strength and physical activity is recommended for better developmental outcomes.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Congenital diaphragmatic hernia (CDH) poses risks for poor developmental outcomes in children.
- School-age CDH survivors require assessment for motor and functional characteristics.
- Identifying perinatal factors linked to motor deficits is crucial for targeted interventions.
Purpose of the Study:
- To evaluate the motor and functional status of school-age children with a history of CDH.
- To identify specific perinatal factors that correlate with motor function deficits in CDH survivors.
Main Methods:
- Comprehensive motor function assessments in 24 CDH survivors (6-10 years) and 72 controls.
- Evaluated physical activity, grip strength, sit-to-stand, single-leg stance, 6-minute walk test, and 3D gait analysis.
- Correlated perinatal factors with motor outcomes in the CDH group.
Main Results:
- CDH survivors showed reduced stature, weight, and physical activity compared to controls.
- Significantly impaired grip strength, sit-to-stand, single-leg stance, and 6-minute walk distance in the CDH group.
- Higher observed-to-expected lung area-to-head circumference ratio (o/e LHR) correlated with better grip strength in CDH survivors.
Conclusions:
- School-age CDH survivors exhibit significant motor function impairments.
- Grip strength assessment is vital, especially for those with a low o/e LHR.
- Interventions targeting muscle strength, balance, endurance, and physical activity are recommended for CDH survivors.
Background:
Children born with congenital diaphragmatic hernia (CDH) are at risk of poor developmental outcomes. This study aimed to clarify the motor and functional characteristics of school-age CDH survivors and identify perinatal factors associated with motor function deficits.
Methods:
Motor function was comprehensively assessed in CDH survivors aged 6-10 years (CDH group, n=24) and in age- and sex-matched controls (n=72). Assessments included physical activity time, grip strength, the five times sit-to-stand test, one-leg standing time, 6 min walking distance and gait ability using a three-dimensional gait analysis. In the CDH group, correlations between perinatal factors and motor function outcomes were analysed.
Results:
In the CDH group, all children had isolated CDH. Three were extracorporeal membrane oxygenation (ECMO) treated and 21 were non-ECMO treated. The CDH group exhibited shorter stature, lower weight and reduced physical activity time than the controls. They also showed significantly lower grip strength, longer five times sit-to-stand test time, shorter one-leg standing time and decreased 6 min walking distance. No significant differences were found between the two groups regarding walking speed, step length or Gait Deviation Index. Within the CDH group, a higher observed-to-expected lung area-to-head circumference ratio (o/e LHR) was positively correlated with better grip strength.
Conclusions:
School-age survivors of CDH are at risk of impaired motor function. Particularly, grip strength measurement is crucial for those born with a low o/e LHR. Implementing follow-up and intervention programmes focused on improving limb muscle strength, balance, and endurance, and promoting adequate physical activity may enhance motor function.
