ABSTRACT
Croup is a frequent cause of outpatient and emergency consultation. It is frequently triggered by a viral respiratory infection and characterized by an abrupt onset. We describe current studies about the treatment of croup. The use of systemic corticosteroids stands out as choice treatment, and nebulized epinephrine as short term therapy while waiting for the anti-inflammatory effect of steroids.
El Croup (laringitis aguda) es motivo frecuente de consulta en servicios de urgencia y policlínicos pediátricos. Generalmente es gatillado por una infección respiratoria viral y se caracteriza por un inicio abrupto. En el presente texto se describen los estudios vigentes acerca de su tratamiento. Destacan los corticoides sistémicos como terapia de elección y la adrenalina nebulizada como terapia de acción corta en espera de la acción antinflamatoria esteroidal.
Subject(s)
Humans , Child , Croup/diagnosis , Croup/drug therapy , Adrenal Cortex Hormones/therapeutic use , Dexamethasone/therapeutic use , Laryngitis/diagnosis , Laryngitis/drug therapy , Prednisolone/therapeutic use , Respiratory SoundsABSTRACT
El tratamiento de la laringitis aguda en los niños, sigue siendo muy controvertido. Mientras que algunos sugieren no tratar las laringitis leves argumentando que se trata de un proceso benigno y autolimitado, otros están a favor de brindar tratamiento farmacológico, ya que éste puede ofrecer beneficios. Tanto el budesonide nebulizado como los corticoides orales, han demostrado mejorar la sintomatología inicial de la laringitis leve a moderada, disminuir el tiempo de estadía en el área de observación de urgencias, disminuir los ingresos hospitalarios y la necesidad de intubacíón. La revisión de la literatura mostró que el budesonide y la dexametasona oral, en monodosis, son igualmente eficaces. A la hora de elegir una vía de administración de los corticoides, debe tenerse en cuenta la disponibilidad de la droga, la edad y la colaboración del paciente y de sus padres. Considerando estos parámetros, parecería que la dexametasona oral se convierte en el tratamiento de elección para niños con laringitis leve a moderada, ya que es más económica, está más disponible que el budesonide, y su administración es más sencilla que la nebulización.
Subject(s)
Humans , Male , Female , Child , Budesonide/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Croup/drug therapy , Croup/therapy , Dexamethasone/administration & dosage , Laryngitis , Laryngitis/drug therapyABSTRACT
Introducción: Laringotraqueobronquitis (LTB) es una condición frecuente en niños, con escasos estudios publicados en la literatura nacional. Objetivo: Caracterizar los episodios de LTB en nuestra institución. Método: Estudio retrospectivo descriptivo del 2001 al 2003. Resultados: 68 pacientes sufrieron 72 episodios de LTB. La edad promedio fue 16,5 meses, 62 por ciento eran varones. La mayoría de los ingresos ocurrieron en otoño (65 por ciento). El número de días promedio de síntomas previo al ingreso fue 2, siendo los más frecuentes estridor (85 por ciento), tos seca (78 por ciento) y fiebre (72 por ciento). La estadía promedio duró 1 día. Se identificó virus Parainfluenza en 12 de 23 inmunofluorescencias. La terapia incluyó adrenalina (100 por ciento), corticoides (96 por ciento), oxígeno (15 por ciento), salbutamol (11 por ciento) y antibióticos (11 por ciento). Las complicaciones fueron neumonía (3 por ciento) y traqueitis bacteriana (2 por ciento). Conclusión: En nuestra serie, LTB fue más frecuente en varones y menores de 2 años, con clara estacionalidad, estadías hospitalarias cortas y un bajo riesgo de complicaciones.
Subject(s)
Male , Humans , Female , Infant , Child, Preschool , Bronchitis/epidemiology , Bronchitis/virology , Croup/epidemiology , Croup/virology , Parainfluenza Virus 1, Human , Age Distribution , Anti-Inflammatory Agents/therapeutic use , Bronchodilator Agents/therapeutic use , Bronchitis/drug therapy , Chile/epidemiology , Croup/drug therapy , Epidemiology, Descriptive , Hospitalization , Nebulizers and Vaporizers , Retrospective Studies , Respiratory Sounds/etiology , SeasonsABSTRACT
OBJECTIVE: To compare the effectiveness and side effects of nebulized l-epinephrine (NLE) at a dose of 0.05 mL/kg versus 0.5 mL/kg in the treatment of postintubation croup in children. MATERIAL AND METHOD: Thirty-nine children, who developed signs and symptoms of upper airway obstruction (UAO) after extubation, were randomized to receive either 0.05 mL/kg or 0.5 mL/kg of NLE. UAO scores, vital signs (VS) and possible side effects were recorded before and at 20 and 40 minutes after the treatment. RESULTS: Twenty-one and 18 patients were allocated to the 0.05 and 0.5 mL/kg groups, respectively. Both groups showed improvements in UAO scores over time. There were no significant differences in UAO scores and VS between the groups at all time points. Side effects of epinephrine were not observed. CONCLUSION: In children with postintubation croup, the administration of NLE at the dose of 0.05 mL/kg results in similar improvements in the UAO scores, compared with the dose of 0.5 mL/kg. No complications were seen in either dose.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Airway Obstruction/drug therapy , Child , Child, Preschool , Croup/drug therapy , Drug Therapy, Combination , Epinephrine/administration & dosage , Female , Humans , Infant , Intensive Care Units, Pediatric , Intubation, Intratracheal/adverse effects , Male , Nebulizers and Vaporizers , Prospective Studies , Vasoconstrictor Agents/administration & dosageSubject(s)
Anti-Inflammatory Agents/therapeutic use , Child , Croup/drug therapy , Humans , SteroidsABSTRACT
Infectious croup is a common and an important cause of upper airway obstruction in young children. Despite its frequency and potentially serious nature, there is still no definite conclusion regarding the beneficial effect of corticosteroid. A randomized controlled study on the effects of dexamethasone in infectious croup was conducted at the Department of Pediatrics, Ramathibodi Hospital between January 1985 and September 1986. Thirty-two patients, 2-37 months old, were included in this study. Fourteen patients received dexamethasone (0.5 mg/kg/dose daily for 3 days) and eighteen patients were the control group. The dexamethasone group had significantly lower croup scores at 48 hour (p < 0.05), shorter hospital course (p < 0.005) and lower incidence of endotracheal intubation (p < 0.05) than the control group. Five patients in the control group required endotracheal intubation. Complications included four episodes of pneumonia, one episode of sepsis, and one bacterial tracheitis. Pneumonia and sepsis occurred only in the control group. We concluded that dexamethasone therapy decrease the severity of infectious croup and the risk of complications.
Subject(s)
Airway Obstruction/prevention & control , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Child, Preschool , Croup/drug therapy , Dexamethasone/administration & dosage , Female , Humans , Infant , Intubation, Intratracheal , Male , Pneumonia/etiology , Sepsis/etiology , Treatment OutcomeABSTRACT
The administration of corticosteroids by various routes in the treatment of croup remains controversial as studies with varying designs and outcome measures have reported conflicting results. However, meta-analysis supports the use of steroids in croup. A dose equivalent to or greater than 100 mg/kg body weight of hydrocortisone, administered orally or parenterally appears to be effective. Nebulized budesonide in a dose of 1,000 micrograms, when dosages are given 30 minutes apart is also effective. The L-epinephrine is as effective as racemic epinephrine and should be used to relieve symptoms with or without steroids. Summarizing the value of beta agonists, for treatment of bronchiolitis is rather challenging. Beta agonists offer significant relief to only a subgroup of infants, with bronchiolitis, albeit, it remains a challenge to identify these infants prospectively. Availability of RSV immune globulin for prevention of RSV disease in high-risk infants and better defining the role of ribavirin for selected patients may offer additional avenues to the treating physician.