title: Long-term effects of birth order and age at diagnosis in cystic fibrosis: a sibling cohort study.
abstract: BACKGROUND
  Siblings with cystic fibrosis (CF) share many genetic and environmental factors but may present different phenotypes. Younger sibs are mostly earlier diagnosed with CF than their older sibs, but might be at risk for an earlier colonization with Pseudomonas aeruginosa (PA) than their older counterparts due to cross-infection within families.
  
  
  OBJECTIVE
  To analyze the effects of birth order and age at diagnosis on lung function, PA colonization, nutritional status, and survival during the first two decades of life in siblings with CF.
  
  
  METHODS
  A retrospective cohort study of 52 sibling pairs was performed in two Dutch CF centers. Data were analyzed both cross-sectionally and longitudinally using Kaplan-Meier curves and modified log-rank tests.
  
  
  RESULTS
  Median age at diagnosis was significantly higher in the older sib compared with the younger sib (3.0 and 0.2 years, respectively, P < 0.0001). At the age of 5, 10, and 15 years no difference in lung function was found. However, at the age of 20 years, forced expiratory volume in 1 sec (FEV(1)) in older sibs was 19.4% (95% CI: 5.9-32.9%, P = 0.007) lower than in younger sibs. In the younger sibs group, FEV(1) at age 20 years was significantly better in those who had a diagnosis before the age of 6 months (difference 22.9%, 95% CI: 0.1-45.8%, P < 0.05). In the first 10 years of life the younger sibs tended to be earlier colonized with PA than their older counterparts. No differences in nutritional status and survival were observed.
  
  
  CONCLUSIONS
  In this sibling cohort study, an early diagnosis of CF was associated with better lung function after two decades of life. Although younger siblings tended to be colonized with PA at an earlier age, they showed better lung function outcomes. This underscores the importance of early diagnosis with newborn screening and early referral to a specialized center in the prevention of long-term deleterious effects on lung function.
authors.affiliation: Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands. m.g.slieker@umcutrecht.nl
authors.forename: M G
authors.initials: MG
authors.lastname: Slieker
authors.forename: J M W
authors.initials: JM
authors.lastname: van den Berg
authors.forename: J
authors.initials: J
authors.lastname: Kouwenberg
authors.forename: F Teding
authors.initials: FT
authors.lastname: van Berkhout
authors.forename: H G M
authors.initials: HG
authors.lastname: Heijerman
authors.forename: C K
authors.initials: CK
authors.lastname: van der Ent
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D011552:Pseudomonas Infections / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D035781:Siblings; D013995:Time; D055815:Young Adult
chemical_list: D019005:Cystic Fibrosis Transmembrane Conductance Regulator