Evolution of pulmonary inflammation and nutritional status in infants and young children with cystic fibrosis

Ranganathan, Sarath C., Parsons, Faith, Gangell, Catherine, Brennan, Siobhan, Stick, Stephen M., Sly, Peter D. and on behalf of the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) (2011) Evolution of pulmonary inflammation and nutritional status in infants and young children with cystic fibrosis. Thorax, 66 5: 408-413. doi:10.1136/thx.2010.139493

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Author Ranganathan, Sarath C.
Parsons, Faith
Gangell, Catherine
Brennan, Siobhan
Stick, Stephen M.
Sly, Peter D.
on behalf of the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF)
Title Evolution of pulmonary inflammation and nutritional status in infants and young children with cystic fibrosis
Journal name Thorax   Check publisher's open access policy
ISSN 0040-6376
1468-3296
Publication date 2011-05-01
Sub-type Article (original research)
DOI 10.1136/thx.2010.139493
Volume 66
Issue 5
Start page 408
End page 413
Total pages 6
Place of publication London, United Kingdom
Publisher BMJ Group
Collection year 2012
Language eng
Formatted abstract
Introduction
Improved nutrition is the major proven benefit of newborn screening programmes for cystic fibrosis (CF) and is associated with better clinical outcomes. It was hypothesised that early pulmonary inflammation and infection in infants with CF is associated with worse nutrition.

Methods

Weight, height and pulmonary inflammation and infection in bronchoalveolar lavage (BAL) were assessed shortly after diagnosis in infants with CF and again at 1, 2 and 3 years of age. Body mass index (BMI) was expressed as z-scores. Inflammatory cells and cytokines (interleukin 1β (IL-1β), IL-6, IL-8 and tumour necrosis factor α (TNFα)), free neutrophil elastase activity and myeloperoxidase were measured in BAL. Mixed effects modelling was used to assess longitudinal associations between pulmonary inflammation, pulmonary infection (Staphylococcus aureus and Pseudomonas aeruginosa) and BMI z-score after adjusting for potential confounding factors.

Results
Forty-two infants were studied (16 (38%) male; 39 (93%) pancreatic insufficient); 36 were diagnosed by newborn screening (at median age 4 weeks) and six by early clinical diagnosis (meconium ileus). Thirty-one (74%) received antistaphylococcal antibiotics. More than two-thirds were asymptomatic at each assessment. Mean BMI z-scores were −1.5 at diagnosis and 0.5, −0.2 and −0.1 at 1, 2 and 3 years, respectively. Neutrophil elastase and infection with S aureus were associated with lower BMI, whereas age (p=0.01) and antistaphylococcal antibiotics (p=0.013) were associated with increased BMI. On average, each log10 increase in free neutrophil elastase activity was associated with a 0.43 (95% CI 0.06 to 0.79) reduction in BMI z-score.

Discussion
Early nutritional status is associated with the underlying pulmonary pathophysiology in CF, and better understanding of these relationships is required. Studies are required to assess whether interventions can decrease pulmonary inflammation and improve nutrition. Early surveillance will enable such targeted interventions with the aim of improving these important clinical outcomes.
Keyword Lower Airway Inflammation
Body-Mass Index
Lung-Function
Diagnosis
Aeruginosa
Mortality
Survival
Weight
Growth
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published Online First 12 March 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
Official 2012 Collection
School of Medicine Publications
 
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Created: Mon, 12 Sep 2011, 01:31:24 EST by System User on behalf of School of Medicine