Published online June 20, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e531-e537 (doi:10.1542/10.1542/peds.2006-1414)

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Padman, R. Search for Related Content PubMed Articles by Padman, R. Related Collections Respiratory Tract Social Bookmarking                         What's this?

ARTICLE

Infant Care Patterns at Epidemiologic Study of Cystic Fibrosis Sites That Achieve Superior Childhood Lung Function

Raj Padman, MD^a, Susanna A. McColley, MD^b, Dave P. Miller, MS^c, Michael W. Konstan, MD^d, Wayne J. Morgan, MD^e, Michael S. Schechter, MD, MPH^f, Clement L. Ren, MD^g, Jeffrey S. Wagener, MD^h for the Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis

^a Department of Pediatrics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Delaware
^b Department of Pulmonary Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
^c Ovation Research Group, San Francisco, California
^d Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
^e Departments of Pediatrics and Physiology, University of Arizona, Tucson, Arizona
^f Department of Pediatrics, Brown University, Providence, Rhode Island
^g Department of Pediatrics, University of Rochester, Rochester, New York
^h Genentech, Inc, South San Francisco, California

OBJECTIVE. Previous analyses of the Epidemiologic Study of Cystic Fibrosis database revealed that sites with the highest average patient lung function monitor patients and treat with antibiotics more aggressively than those where average lung function is lowest. The aim of this study was to assess whether patterns of care for infants at cystic fibrosis sites with superior average lung function in 6- to 12-year-old children showed any differences from those at the lowest outcome sites.

METHODS. We divided cystic fibrosis sites with 20 patients who were 6 to 12 years of age into quartiles on the basis of median forced expiratory volume in 1 second of that age group in 2003 and compared demographic and clinical characteristics and treatment patterns during the first year of enrollment for patients who were aged 0 to 3 years at those sites in 1994 to 1999. The analysis included 755 infants from 12 upper quartile sites and 743 infants from 12 lower quartile sites.

RESULTS. Upper quartile sites had more infants whose disease was diagnosed by family history or newborn screening, fewer infants with symptoms at diagnosis, higher weight for age at enrollment, more white patients, and more F508 homozygotes. Medical conditions and respiratory tract microbiology differed between sites. Infants at upper quartile sites had more office and sick visits; more respiratory tract cultures; and more frequent use of intravenous antibiotics, oral corticosteroids, mast cell stabilizers, and mucolytics; but they received less chest physiotherapy, inhaled bronchodilators, oral nutritional supplements, and pancreatic enzymes.

CONCLUSIONS. Both enrollment characteristics and infant care patterns are associated with lung function outcomes in later childhood. Our analysis suggests that pulmonary function of older children may be improved through specific interventions during the first 3 years of life.

---

Key Words: cystic fibrosis • early practice patterns • lung function outcomes

Abbreviations: CF—cystic fibrosis • ESCF—Epidemiologic Study of Cystic Fibrosis • FEV₁—forced expiratory volume in 1 second • UQ—upper quartile • LQ—lower quartile

---

Accepted Sep 18, 2006.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				I. M Balfour-Lynn Cystic fibrosis papers of the year 2007 J R Soc Med, July 1, 2008; 101(Supplement_1): 10 - 14. [Full Text] [PDF]