Evolução das alterações radiológicas pulmonares de pacientes com fibrose cística nos primeiros 6 anos de vida

Abstract

Introduction: Cystic fibrosis (CF) is a severe genetic disease involving multiple organs, and lung disease is the leading cause of morbidity and mortality. The pulmonary evaluation of children under 6 years old is limited and based on chest radiography. Neonatal screening is important for early diagnosis, however there are few studies on its impact on the progression of pulmonary infection-inflamation cycle. Objective: To evaluate development of radiological changes of CF in patients until5 years old through Brasfield score and analyze its differences according to pulmonary colonization with Pseudomonas aeruginosa (PA) and Staphylococcus aureus sensitive to oxacilin (OSSA) and with the diagnose form, if by neonatal screening or not. Methodology: It is a cross-sectional study that evaluated 254 chest radiographsof 67 patients from The CF Outpatient of Hospital das Clínicas (HC) atUniversidade Federal de Minas Gerias (UFMG) with diagnose confirmed or not by neonatal screening and who had done airway cultures as part of routine care. The interpretation of radiographs were performed by the autor based on the Brasfield score. Statistical analysis was based on Kruskal Wallis test, nonparametric, and with a significance level of 5%. Results: Approximately 35,8% of the radiographs showed Brasfield score below 21 points, compatible with potentially irreversible lung disease, and from four years old the average score was below this value. According to the increasing children ages, it has increased the average severity of linear opacities and nodular cystic lesions of the Brasfield score. Neonatal screening was related to less severeradiographic changes. The cronic colonization by PA was associated with greater severity of radiographic findings regarding patients never colonized or with a history of one or two acute infections by this bacterium.Conclusion: Radiographic evaluation of the chest through the Brasfield score wasable to show the first lung changes of CF and identified the age group from which the changes became more pronounced. Neonatal screening and prevention methods for chronic infection with PA seems to exert a protective effect on progression of lung disease in CF.