Croup

Definitions

  • Acute Infectious Croup (Acute Laryngotracheobronchitis): contagious disease in otherwise healthy children
    • Often associated with respiratory illness in the family
  • Acute Spasmodic Croup: most common in young children who are prone to recurrent attacks
    • Possibly precipitated by a viral respiratory infection, allergic factors, or other factors
    • Fever is usually absent
    • Symptoms usually resolve within several hours

Epidemiology

  • Peak Age: <6 y/o

Etiology


Physiology

  • Infection of upper airway with rapid onset of glottic closure -> upper airway obstruction

Diagnosis

  • CXR: glottic/subglottic edema -> may aid in differentiation from acute epiglottitis (although radiographs are of limited accuracy)

Clinical Manifestations

General Comments

  • Symptoms are preceded by several days of an upper respiratory illness
  • Symptoms are often worse at night
  • A fluctuating course is typical

Otolaryngologic Manifestations

  • Acute Upper Airway Obstruction (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
    • Acute Respiratory Failure (see Respiratory Failure, [[Respiratory Failure]]): due to high-grade upper airway obstruction with excessive work of breathing
    • Inspiratory Stridor (see Stridor, [[Stridor]])
  • Hoarseness (see Hoarseness, [[Hoarseness]])

Pulmonary Manifestations

  • Brassy or Barking Cough (see Cough, [[Cough]])
  • Dyspnea (see Dyspnea, [[Dyspnea]])

Other Manifestations

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Treatment

Natural Course

  • A fluctuating course is typical

Supportive Care

  • Humidified Oxygen/Mist Therapy

Hospitalization

  • Home Management: since most children have symptoms which decrease in intensity over several days, they can be managed at home
    • However, monitoring for upper airway obstruction is crucial

Nebulized Racemic Epinephrine (see Epinephrine, [[Epinephrine]])

  • Indications: used for symptomatic relief of upper airway obstruction
  • Mechanism: alpha adrenergic effect is believed to cause mucosal vasoconstriction, resulting in decreased subglottic edema
  • Latency: min
  • Duration of Action: <2 hr
  • Clinical Efficacy: has not been demonstrated to improve oxygenation

Corticosteroids (see Corticosteroids, [[Corticosteroids]])

  • Indications: mild, moderate, and severe croup
    • Single-dose corticosteroids is probably indicated in any child with severe enough croup to require an emergency room or clinic visit
  • Clinical Efficacy
    • Increase rate of symptomatic improvement
    • Decrease hospital length of stay
    • Decrease the rate of intubation
  • Adverse Effects: single-dose corticosteroids does not have significant adverse effects

Anti-Viral Agents

  • Have not been evaluated in croup

Antibiotics

  • Likely have no clinical benefit

References

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