Pulmonary radiographic findings in young children with cystic fibrosis

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.