Lung function in infants with cystic fibrosis diagnosed by newborn screening
Barry M Linnane1, Graham L Hall, Gary Nolan
1Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Australia.
Insights
Lung function in infants with cystic fibrosis (CF) is normal at diagnosis but declines by 6 months of age. Early intervention within the first six months is crucial for preserving lung health in CF patients.
Area of Science:
- Pediatric Pulmonology
- Genetic Diseases
- Respiratory Medicine
Background:
- Progressive lung damage in cystic fibrosis (CF) begins in infancy.
- Early detection and intervention are key for managing CF progression.
- Newborn screening enables early diagnosis of CF.
Purpose of the Study:
- To assess lung function in infants diagnosed with CF via newborn screening.
- To investigate the relationship between lung function, pulmonary infection, and inflammation in infants with CF.
Main Methods:
- Studied infants with CF (n=68) and healthy controls (n=49) aged 6 weeks to 30 months.
- Measured lung function using forced vital capacity, FEV(0.5), and FEF(75) via the raised-volume rapid thoracoabdominal compression technique.
- Collected bronchoalveolar lavage (BAL) samples from CF infants for infection and inflammation analysis.
Main Results:
- Lung function (FEV(0.5) z score) was normal in infants with CF under 6 months compared to controls.
- Lung function significantly decreased in CF infants older than 6 months.
- Pulmonary infection and inflammation did not correlate with the observed lung function deficits.
Conclusions:
- Infants with CF show normal lung function at diagnosis but diminished function by 6 months of age.
- Therapeutic interventions in CF should ideally commence within the first 6 months of life.
- Early intervention is critical for preserving lung function in infants with CF.
Rationale:
Progressive lung damage in cystic fibrosis (CF) starts in infancy, and early detection may aid preventative strategies.
Objectives:
To measure lung function in infants with CF diagnosed by newborn screening and describe its association with pulmonary infection and inflammation.
Methods:
Infants with CF (n = 68, 6 weeks to 30 months of age) and healthy infants without CF (n = 49) were studied. Forced vital capacity, FEV(0.5), and forced expiratory flows at 75% of exhaled vital capacity (FEF(75)) were measured using the raised-volume rapid thoracoabdominal compression technique. Forty-eight hours later, infants with CF had bronchoalveolar lavage (BAL) for assessment of pulmonary infection and inflammation.
Measurements And Main Results:
In the CF group, the deficit in FEV(0.5) z score increased by -0.77 (95% confidence interval, -1.14 to -0.41; P < 0.001) with each year of age. The mean FEV(0.5) z score did not differ between infants with CF and healthy control subjects less than 6 months of age (-0.06 and 0.02, respectively; P = 0.87). However, the mean FEV(0.5) z score was lower by 1.15 in infants with CF who were older than 6 months of age compared with healthy infants (P < 0.001). FVC and FEF(75) followed a similar pattern. Pulmonary infection and inflammation in BAL samples did not explain the lung function results.
Conclusions:
Lung function, measured by forced expiration, is normal in infants with CF at the time of diagnosis by newborn screening but is diminished in older infants. These findings suggest that in CF the optimal timing of therapeutic interventions aimed at preserving lung function may be within the first 6 months of life.
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