Croup - assessment and management.

BACKGROUND: Croup is a common childhood disease characterised by sudden onset of a distinctive barking cough that is usually accompanied by stridor, hoarse voice, and respiratory distress resulting from upper airway obstruction. The introduction of steroids in the treatment of croup has seen a significant reduction in hospital admissions and improved outcomes for children. OBJECTIVE: This article discusses the key aspects of diagnosing croup and the evidence supporting the different treatment strategies. DISCUSSION: The assessment of airway, breathing and circulation, focusing on airway, is paramount in treating croup. However, it is important to take care not to cause the child undue distress. In mild to moderate croup, give prednisolone 1.0 mg/kg and review in 1 hour. In severe or life threatening croup, give 4 mL of adrenaline 1:1000 (undiluted) via nebuliser and send immediately to hospital via ambulance.

[Causes of lethal outcomes in croup syndrome in children]. / Prichiny letal'nykh iskhodov pri sindrome krupa u detei.

The paper reports 40 cases of lethal outcomes in children with croup syndrome treated in Morozov Children's Moscow City Hospital in 1985-1998. 92.5% of them died of severe pneumonia complications, 7.5%--of sepsis. 70% of the deceased were infants aged 0-2 years, 75% of them were boys. All the children had aggravated premorbid background. The sputum and organ tissues contained in most cases association of viruses with staphylococci and streptococci resistant to standard antibiotics (penicillin, ampicillin, cefazoline). The conclusion is made that children with croup died primarily of severe pneumonia complications in low systemic reactivity and bacterial-viral association of the agents resistant to the antibacterial therapy.

Do steroids prevent reintubation in children with laryngotracheobronchitis?

BACKGROUND: Classic laryngotrachoebronchitis (LTB) is an inflammatory process, with oedema and secretions that involve the entire laryngotracheobronchial tree. The severity of lower airway disease in African children with LTB has previously been documented. The aim of the present study was to determine whether steroids prevent reintubation in African children with classic LTB. METHOD AND RESULTS: The study was a retrospective analysis from January 1993 to December 1996. Eighty-two black children with LTB were mechanically ventilated in the intensive care unit (ICU). By univariate regression, the estimated B coefficients for variables such as age, pneumonia, days of intubation, arterial partial oxygen tension (PaO2) : fractional inspired oxygen (FIO2) ratio, atelectasis and antibiotic use were not statistically significant (P > 0.05) as predictors for reintubation. Using multiple regression (all independent variables in combination), none of the variables acted as predictors of reintubation (P = 0.25). Steroids were shown to have no effect alone or in association with other variables in altering reintubation rates. An increase in the days of intubation showed a tendency towards reintubation (P = 0.06) in the univariate analysis (odds ratio 1.00-1.14), but showed no statistically significant difference in multivariate analysis. Of the variables used as predictors of reintubation, none acted either as a preventive factor or as a risk factor. CONCLUSION: The present results suggest that steroids should not be recommended at any stage in treatment of intubated patients with classic LTB. Prospective studies should evaluate the major risk factors for reintubation: duration of intubation, trauma to the airway at intubation and during ICU stay, and dose and timing of steroids. They should also evaluate whether upper airway disease is present alone or in association with lower airway disease.

Acute laryngotracheobronchitis in Nigerian children.

In a prospective study of cases of severe acute respiratory infections seen at the University College Hospital, Ibadan over a 30-month period, 39 cases were found to have acute upper airway obstruction; out of this number, acute laryngotracheobronchitis (croup) accounted for 35 (90%). The ages of the 35 ranged from 2 to 53 months with 86% being less than 3 years old, while there was a male preponderance (M:F ratio, 1.7:1). Croup was associated with bronchopneumonia in 29%, measles in 2.9%, and with both in 40% of the 35 cases. The mean respiratory rate in patients in whom croup co-existed with measles and pneumonia was significantly higher than that in patients with croup alone (P < 0.001). Six (55%) of the eleven viral identifications made were Parainfluenza virus types 1-3, while Respiratory syncytial virus was identified in three patients. Of the 18 blood cultures done, only one was positive, yielding Klebsiella pneumoniae in a two-year old undernourished child with associated measles and bronchopneumonia. Mortality was 11%; all the four children who died had associated bronchopneumonia, which complicated measles infection in three. The findings in this study support the view that antibiotic therapy is not routinely indicated in the management of croup. Furthermore, measles and bronchopneumonia were identified as indicators of poor prognosis requiring extra care in management.