Motor and functional characteristics in school-age survivors of congenital diaphragmatic hernia: a cross-sectional observational study

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.