Early diagnosis of cystic fibrosis in the newborn period and risk of Pseudomonas aeruginosa acquisition in the first 10 years of life: A registry-based longitudinal study
Ss. Wang et al., Early diagnosis of cystic fibrosis in the newborn period and risk of Pseudomonas aeruginosa acquisition in the first 10 years of life: A registry-based longitudinal study, PEDIATRICS, 107(2), 2001, pp. 274-279
Objective. Controlled clinical trial data have suggested that identifying a
symptomatic cystic fibrosis (CF) patients through newborn screening improve
s health outcomes of affected children in the first decade of life. However
, it is unclear whether these improvements also include a reduction in risk
for bronchial infection, the major determinant of CF morbidity. The author
s therefore investigated the association between early CF diagnosis and acq
uisition of Pseudomonas aeruginosa, the major bronchial pathogen, in the fi
rst decade of life.
Methodology. Longitudinal data on 3625 CF patients diagnosed between 1982 a
nd 1990 and before 36 months of age were ascertained from the National Cyst
ic Fibrosis Patient Registry. We compared P aeruginosa acquisition in the f
irst 10 years of life among 4 groups: EAD (early asymptomatic diagnosis)-<
6 weeks, by pre/neonatal screening, genotype, family history (n = 157); ESD
(early symptomatic diagnosis) (n = 227); LAD (late asymptomatic diagnosis)
-6 weeks to 36 months (n = 161); and LSD (late symptomatic diagnosis) (n =
3080). P aeruginosa acquisition was determined from yearly sputum and/or br
onchoscopy cultures. Children whose CF diagnoses followed meconium ileus or
whose cultures were obtained only from nasal samples were excluded from th
e study.
Results. Kaplan Meier analyses for P aeruginosa acquisition were conducted
for each diagnostic group. Regression models were used to generate adjusted
relative hazards with EAD as the referent group. Relative hazards were 0.9
(95% confidence interval [CI]: 0.7-1.2) for ESD, 0.8 (95% CI: 0.6-1.2) for
LAD, and 1.0 (95% CI: 0.7-1.2) for LSD. The risk of acquiring P aeruginosa
was therefore not significantly different between children diagnosed early
, late, asymptomatically, or symptomatically.
Conclusions. These data suggest that, despite improvements in other health
outcomes from newborn screening for CF, early asymptomatic diagnosis of CF
does not affect P aeruginosa acquisition.