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croup (laryngotracheobronchitis)
Acute upper airway obstruction in infants & children.
Etiology:
- parainfluenza viruses 1 & 2
Clinical manifestations:
1) barking cough
2) stridor
3) nasal congestion
4) difficult & noisy respiration
5) cyanosis
5) generally resolves within 1 day in 50% of children & within 2 days in 80% of children [4]
Radiology:
- neck radiograph, AP & lateral
- unnecessary when the clinical suspicion for croup is high
- subglottic narrowing ("steeple sign")
Management:
1) dexamethasone
a) 0.6 mg/kg PO (max 10 mg) single dose
b) 160 ug nebulized is less effective than oral dose [2]
c) NNT = 5 [5]
2) nebulized epinephrine if dexamethasone is needed
3) endotracheal intubation or tracheostomy if needed
4) humidity of no benefit [3]
General
laryngitis
tracheitis
bronchitis
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Journal Watch 22(2):15, 2002
Luria et al Arch Pediatr Adolesc Med 155:1340, 2001
- Scolnik D et al,
Controlled delivery of high vs low humidity vs mist therapy
for croup in emergency departments: A randomized controlled
trial.
JAMA 2006; 295:1274
PMID: 16537737
- Thompson M et al
Duration of symptoms of respiratory tract infections
in children: systematic review.
BMJ 2013;347:f7027
PMID: 24335668
http://www.bmj.com/content/347/bmj.f7027
- The NNT: Glucocorticoids (Steroids) for Croup
http://www.thennt.com/nnt/steroids-for-croup/
- Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP.
Glucocorticoids for croup.
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001955
PMID: 21249651
- Cherry JD.
Clinical practice. Croup.
N Engl J Med 2008 Jan 25; 358:384.
PMID: 18216359
- Bjornson C et al.
Nebulized epinephrine for croup in children.
Cochrane Database Syst Rev 2013 Oct 12; 10:CD006619.
PMID: 24114291