Motor-function and exercise capacity in children with major anatomical congenital
anomalies: An evaluation at 5 years of age
Monique H.M. van der Cammen-van Zijp
, Saskia J. Gischler
, Petra Mazer
, Monique van Dijk
, Hanneke IJsselstijn
Intensive Care and Department of Pediatric Surgery, and Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC-Sophia Children's Hospital, room Sk 0327;
Dr. Molewaterplein 60; 3015 GJ Rotterdam; The Netherlands
Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
Received 6 November 2009
Received in revised form 16 May 2010
Accepted 29 June 2010
Background: Children with major anatomical congenital anomalies (CA) often need prolonged hospitaliza-
tion with surgical interventions in the neonatal period and thereafter. Better intensive care treatment has
reduced mortality rates, but at the cost of more morbidity.
Aim: To study motor-function and exercise capacity in ﬁve-year-old children born with CA, and to determine
whether motor-function and exercise capacity differ according to primary diagnosis.
Study design: Descriptive study.
Subjects: One-hundred-and-two children with the following CA: congenital diaphragmatic hernia (CDH)
n=24, esophageal atresia (EA) n = 29, small intestinal anomalies (SIA) n=25, and abdominal wall defects
(AWD) n = 24.
Outcome measures: Overall and subtest percentile scores of the Movement-Assessment Battery for Children
(M-ABC) were used to measure motor skills. Endurance time on the Bruce treadmill test was used to
determine maximal exercise capacity.
Results: Motor-function: Seventy-three children (71.6%) had an overall percentile score within the normal
range, 18 (17.6%) were classiﬁed as borderline, and 11 (10.8%) had a motor problem. This distribution was
different from that in the reference population (Chi square: p = 0.001). Most problems were encountered in
children with CDH and EA (p = 0.001 and 0.013, respectively). Ball skills and balance were most affected.
Exercise capacity: Mean standard deviation score (SDS) endurance time = −0.5 (SD: 1.3); p=0.001; due to
poor exercise performance in CDH and EA patients.
Conclusions: Children with major anatomical CA and especially those with CDH and EA are at risk for delayed
motor-function and disturbed exercise capacity.
© 2010 Elsevier Ireland Ltd. All rights reserved.
Annually some 5.500 newborns (about 3% of all births) in The
Netherlands present with major anatomical congenital anomalies (CA)
. Children with major anatomical CA often need prolonged
hospitalization with (multiple) surgical interventions in the neonatal
period and thereafter. Better intensive care treatment has reduced
mortality rates, but at the cost of more morbidity. It is therefore that the
Departmentof Pediatric Surgery of our tertiary hospital started in 1999 a
multidisciplinaryfollow-up programfor children born with CA and their
families . The aim of the program is to evaluate and to reduce the
overall morbidity associated with the malformations of the children.
Within this follow-up program, children with CA are tested at ﬁxed time
points. We have recently shown that children with major CA suffer from
psychomotor developmental delay within the ﬁrst two years of life .
And, a recent evaluation of persistent respiratory morbidity in children
born with esophageal atresia (EA) and congenital diaphragmatic hernia
(CDH) revealed disturbed exercise capacity in 5-year-old-survivors .
Further standardized assessment of motor-function and exercise
capacity in school-aged children with major CA other than cardiac
malformations has hardly been published [4,5]. Early identiﬁcation of
children with motor impairments however, is important to provide
support and intervention for the child as early as necessary, since motor
problems do not disappear spontaneously .
The aim of the present study was to determine whether 5-year-old
children with different major CA are at risk for impaired motor-function
and reduced exercise capacity, and to determine whether motor-
function and exercise capacity differ according to primary diagnosis. We
evaluated four different groups of CA patients: children born with CDH,
EA, small intestinal anomalies (SIA), andabdominal wall defects (AWD).
Early Human Development 86 (2010) 523–528
⁎ Corresponding author. Tel.: + 31 10 7036764; fax: +31 10 7036288.
E-mail address: firstname.lastname@example.org
(M.H.M. van der Cammen-van Zijp).
0378-3782/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
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