Treatment of children with cystic fibrosis

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Acta Paediatrica

  Publisher:  & Francis Health Sciences, part of the &

Francis Group

  Issue:  Volume 91, Number 9/2002

Treatment of children with cystic fibrosis: central, local or both?

L.M.E Van Koolwijk , C.S.P.M Uiterwaal , J Van Der Laag , J.H Hoekstra ,

V.A.M Gulmans , C.K Van Der Ent Abstract: Owing to a lack of longitudinal

studies, the effect of centralization of care on pulmonary function and

survival remains unclear. Three different levels of involvement of

centralized care in the treatment of paediatric cystic fibrosis patients

were compared with regard to longitudinal pulmonary function and

nutritional and microbiological status in a 3-y period, and the

literature was reviewed on the possible advantages and disadvantages of

centralized care. The study included 105 paediatric patients attending

the Cystic Fibrosis Centre between January 1997 and January 2001.

Twenty-three patients were treated by local paediatricians according to

the protocol of the Centre and were seen only once a year at the Centre,

for an annual check-up (local care). Forty-one patients were treated at

the Centre only (centralized care). The remaining 41 patients were

treated in close cooperation between the Centre and local hospitals, with

patients visiting the doctors alternately (shared care). The mean annual

changes in pulmonary function and body mass index from all patients, as

well as a microbiological survey, were reviewed. No significant

differences were found between the three groups for annual changes in

FEV1, FVC and body mass index, nor did the review of microbial

colonization show any significant differences between the groups. Because

the groups in this study were relatively small, the results might have

been influenced by lack of power.

Conclusion: In this relatively small group, no differences in pulmonary

function, nutritional status or microbiological colonization between the

three levels of involvement of centralized care could be found. This

could signify that local paediatricians have a special role in the care

for patients with cystic fibrosis, in close cooperation with the

specialists at the Centre.

Becki

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