Abstract
Background
Pulmonary evaluation is one of the greatest challenges in children with cystic fibrosis who are younger than 6 years. Although chest CT can provide the most information for initial and progressive changes in cystic fibrosis, the radiation exposures can lead to significant cumulative exposure in children as they are followed with serial scanning to monitor early and progressive disease. Therefore the systematized study of chest radiographs using the Brasfield score has been used scientifically with the aim of evaluating the evolution of pulmonary abnormalities in children with cystic fibrosis.
Objective
This study was performed to assess the radiologic findings in children younger than 6 years with cystic fibrosis. We used the Brasfield score to compare radiographs performed in patients with Pseudomonas aeruginosa vs. oxacillin-sensitive Staphylococcus aureus and to compare radiographs in children with early vs. delayed diagnosis.
Materials and methods
A total of 254 chest radiographs from 67 children who had undergone material cultures of the airways as part of routine care were evaluated in this cross-sectional study. The statistical analysis was performed by the Kruskal–Wallis test, with a significance level of 5%.
Results
Approximately 35.8% of chest radiographs had a Brasfield score lower than 21 points, which is compatible with potentially irreversible pulmonary disease. Brasfield scores decreased (this score decreases with increasing disease severity) in older children, and both bacterial colonization with Pseudomonas and later diagnosis were associated with lower (greater disease) scores.
Conclusion
The evaluation of radiographs using the Brasfield score demonstrated the most important pulmonary findings in cystic fibrosis and identified the age group when these alterations began to appear more pronounced.
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References
Farrel PM, Li Z, Kosorok MR et al (2003) Bronchopulmonary disease in children with cystic fibrosis after early or delayed diagnosis. Am J Respir Crit Care Med 168:1100–1108
Sanders DB, Li Z, Rock MJ et al (2012) The sensitivity of lung disease surrogates in detecting chest CT abnormalities in children with cystic fibrosis. Pediatr Pulmonol 47:567–573
Rosenfeld M, Farrell PM, Kloster M et al (2013) Association of lung function, chest radiographs and clinical features in infants with cystic fibrosis. Eur Respir J 42:1545–1552
Farrel PM, Li Z, Kosorok MR et al (2003) Longitudinal evaluation of bronchopulmonary disease in children with cystic fibrosis. Pediatr Pulmonol 36:230–240
Brasfield D, Hicks G, Soong S et al (1979) The chest roentgenogram in cystic fibrosis: a new screening system. Pediatrics 63:24–29
Cleveland RH, Neish AS, Zurakowski D et al (1998) Cystic fibrosis: a system for assessing and predicting progression. AJR Am J Roentgenol 170:1067–1072
Cleveland RH, Neish AS, Zurakowski D et al (1998) Cystic fibrosis: predictors of accelerated decline and distribution of disease in 230 patients. AJR Am J Roentgenol 171:1311–1315
Sawicki GS, Ayyagari R, Zhang J et al (2013) A pulmonary exacerbation risk score among cystic fibrosis patients not receiving recommended care. Pediatr Pulmonol 48:954–961
Regelmann WE, Schechter MS, Wagener JS et al (2013) Investigators of the epidemiologic study of cystic fibrosis. Pulmonary exacerbations in cystic fibrosis: young children with characteristic signs and symptoms. Pediatr Pulmonol 48:649–657
Oliveira MCLA, Reis FJC, Penna FJ et al (2002) Prognostic factors in cystic fibrosis in a single center in Brazil: a survival analysis. Pediatr Pulmonol 34:3–10
Canton R, Cobos N, de Gracia J et al (2005) Antimicrobial therapy for pulmonary pathogenic colonization and infection by Pseudomonas aeruginosa in cystic fibrosis patients. Clin Microbiol Infect 11:S690–S703
Moore BM, Laguna TA, Liu M et al (2013) Increased adherence to CF practice guidelines for pulmonary medications correlates with improved FEV1. Pediatr Pulmonol 48:747–753
Stick SM, Brennan S, Murray C et al (2009) Bronchiectasis in infants and preschool children diagnosed with cystic fibrosis after newborn screening. J Pediatr 155:623–628
Robroeks CM, Roozeboom MH, de Jong PA et al (2010) Structural lung changes, lung function, and non-invasive inflammatory markers in cystic fibrosis. Pediatr Allergy Immunol 21:493–500
Kosorok MR, Zeng L, West SE et al (2001) Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition. Pediatr Pulmonol 32:277–287
Mayer-Hamblett N, Rosenfeld M, Treggiari MM et al (2013) Standard care versus protocol based therapy for new onset Pseudomonas aeruginosa in cystic fibrosis. Pediatr Pulmonol 48:943–953
Zobell JT, Young DC, Waters CD et al (2013) Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: VI. Executive summary. Pediatr Pulmonol 48:525–537
Eber E, Zach MS (2010) Pseudomonas aeruginosa infection in cystic fibrosis: prevent, eradicate or both? Thorax 65:849–851
Acknowledgments
This article received support in the English revision from Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais.
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Pedrosa, J.F., da Cunha Ibiapina, C., Alvim, C.G. et al. Pulmonary radiographic findings in young children with cystic fibrosis. Pediatr Radiol 45, 153–157 (2015). https://doi.org/10.1007/s00247-014-3112-z
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DOI: https://doi.org/10.1007/s00247-014-3112-z