EMmedonline

• Croup (laryngotracheobronhitis) is the most common cause for stridor outside neonatal period.

• Children's between 6 months and three years are most commonly affected, with peak in the second year of life.

• The most commonest virus detected are parainfluenza, respiratory syncytial virus, human bocavirus and rhinovirus.

Clinical Feature

• Typically begins with 1-2 days of nasal congestion, rhinorrhea, cough and low grade fever before onset of classic croup symptom.

• Classic symptoms include a harsh cough often described as barking or like a seal, hoarse voice and stridor.

• Symptoms are worse at night.

• Duration of symptoms ranges from 3-7 days.

Diagnosis

• Diagnosis is mainly clinical

• Xray : Not necessary routinely. It is used for evaluation of other causes of stridor. Chest Xray may demonstrate subglottic narrowing called the steeple sign.

Assessment of severity

Treatment

• Adrenaline

  Nebulized adrenaline is the main stay of treatment for moderate to severe croup patients with marked retractions and stridor at rest.

  • Adrenaline rapidly reduces the airway edema through vasoconstrictive alpha effect.

  • Clinical effect are seen in 10 min and last upto 1 hour.

  • Beta agonist should not be used in children's as stimulation of beta receptors will lead to vasodilation and worsen edema and exacerbate airway obstruction.

  • Dose : Adrenaline (1:1000) 0.05 ml/kg nebulised (Max: 5 ml)

• Corticosteroids

• All children's with croup benefits from corticosteroids

• Corticosteroids improves symptoms by anti inflamamtory effect in the upper airway.

• Dexamethasone is effectively parenterally and orally. Budensonide can be used alternatively.

• Dose : 0.15 – 0.6 mg/kg PO/IM (Max: 10mg)

• Budensonide : 2mg nebulised.

• Heliox

  • Heliox may be a treatment option in serve refractory croup.

Criteria for Discharge from ED

Updated on : 7/2/14

Reference

• Tintinalli