Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. These standard doses can be used in all patients irrespective of their age and weight . Humidified air inhalation for treating croup. Racemic epinephrine, given by nebulizer, is thought to stimulate alpha-adrenergic receptors with subsequent constriction of arterioles and decreased laryngeal edema. Two studies compared oral dexamethasone with oral prednisolone. However, one randomized controlled trial demonstrated that nebulized L-epinephrine is safe and equally effective.
Croup occurs most commonly between the ages of 1 and 6 years, with a peak incidence being around 18 months of age and the majority of cases below 3 years of age. They appear more toxic, stridorous, apprehensive, have higher fever e.
Patients will often be tachycardic and tachypneic. Alveolar gas exchange is usually normal, with hypoxia seen only in severe cases. The child with epiglottitis may prefer to adopt a position of sitting up, leaning forward, with their chin pushed forward and they may refuse to lie down. Indications for specialist referral Summary Croup is a common early childhood illness, which presents with a barking cough that is worse at night and is associated with a harsh inspiratory stridor and signs of respiratory distress in more severe cases.
One meta-analysis of six studies suggested that a higher dose could be more beneficial in children with severe disease . Respiratory viruses in laryngeal croup of young children [published correction appears in J Pediatr. Evidence-based approach to croup management Although only 5 per cent of affected children require hospital admission,8 croup is a sufficiently common illness that this translates to a significant impact in terms of cost and healthcare resource utilisation.
Repeat doses are rarely given .
Am J Dis Child. Pediatrics ; 3 —8. However, stridor at rest warrants further intervention. Declaration of interests None to declare. Dexamethasone has been found to improve the Westley score at 6 and 12 hours but not at 24 hours , with a NNT of 5 to improve the score . Glucocorticoids for croup.
Last updated: Aug 7 In this section. Visualization of the epiglottis should not be attempted, unless clinical suspicion is low or respiratory failure occurs. He has a dry barking cough and a hoarse cry. White blood cell counts greater than 20, with bandemia may suggest bacterial superinfection.
Dusky or cyanotic without supplemental oxygen CNS Central nervous system. Mild croup can generally by managed at home, although hospital admission might be considered as a precautionary measure in children with risk factors for developing severe disease see Table 4. Table 1. A lateral neck X-ray reveals no prevertebral soft tissue widening or evidence of epiglottitis.
Johnson D, Williamson J. This section reviews the current evidence base for and against the use of various potential croup therapies that have recently been studied. This article discusses the approach to clinical assessment and evidence-based management of childhood croup in both hospital and primary care settings. Their sleep is improved and their parents report less stress . The three characteristic findings on lateral neck X-ray are: a swollen epiglottis thumb sign , thickened aryepiglottic folds and obliteration of the vallecula pre-epiglottic space.
More severe cases may involve nasal flaring, moderate tachypnea, retractions and cyanosis. Indications for specialist referral Summary Croup is a common early childhood illness, which presents with a barking cough that is worse at night and is associated with a harsh inspiratory stridor and signs of respiratory distress in more severe cases. Arch Dis Child ;56 5 — Parental education and support is an essential component of effective management; in particular, parents should be reassured about the short and self-limiting nature of the illness, but warned that symptoms are usually worse at night and may recur after apparently having disappeared during the day. Heliox is occasionally used in severe cases to avoid intubation. The subglottic region is mildly narrowed.