Persisting Motor Function Problems in School-Aged Survivors of Congenital Diaphragmatic Hernia

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.

Fetoscopic Endoluminal Tracheal Occlusion for Severe, Left-Sided Congenital Diaphragmatic Hernia

“…The data also do not include long-term outcomes, nor was postnatal care standardized. Accordingly, we cannot report long-term morbidity relevant to ECMO use, 22 which was significantly affected by fetoscopic endoluminal tracheal occlusion on subanalysis. Additional measures of pulmonary hypertension and cardiac function not captured in this study might explain why this group required less ECMO.…”

Long-term follow-up of patients with congenital diaphragmatic hernia

“…[115][116][117][118] Neurodevelopment beyond 5 years of age warrants continued evaluation as deficits can persist into school-age children and even adulthood. 103 105 Schiller and colleagues have completed multiple studies on neurodevelopmental outcomes in CDH survivors. Their work supports the theory that neonates with a neurological insult may have deficits that become apparent with older age when higher neurocognitive processing is needed.…”

Long-term neurodevelopment in children with resected congenital lung abnormalities

“…We hypothesized that surgery for symptomatic CLA may put children at risk for neurocognitive and motor impairments, as exposure to general anesthesia in childhood and cardiac surgery in infancy have been associated with inferior neurodevelopmental outcomes [29]. Furthermore, survivors of neonatal critical illness and patients with congenital diaphragmatic hernia are more likely to experience motor function problems in childhood [30].…”