The effect of musculoskeletal abnormalities on lung function in children born with congenital diaphragmatic hernia

BACKGROUND: Chest wall deformities (CWD) and scoliosis are common comorbidities in congenital diaphragmatic hernia (CDH) survivors. Their effects on lung function remain unclear. METHODS: We retrospectively analysed 184 CDH patients treated in our clinic between 1999 and 2025, of whom 166 (90.2%) survived until discharge. We matched patients with varying degrees of musculoskeletal abnormalities to controls from our cohort and compared spirometry data. RESULTS: 6.7% of patients had scoliosis and 57.9% had CWD, most commonly asymmetry of the chest (46.4%) and pectus excavatum (42.1%). CWD were usually ipsilateral (95.4%) but the convexity of scoliosis varied. 5/12 scoliosis patients received treatment, and none of the CWD patients. Moderate CWD was associated with lower forced vital capacity in univariate (Z-score effect size -2.08, p < 0.01) and multivariate (-1.53, p = 0.015) analyses. CONCLUSIONS: Chest wall deformities are common in children born with congenital diaphragmatic hernia. More severe chest wall deformities in CDH were associated with a lower forced vital capacity.