Are cytokines and cortisol important predictors for the severity of pediatric croup: A case control study.

Üzüm Ö, Çaglar A, Küme T, Sayiner A, Er A, Akgül F, Ulusoy E, Yilmaz D, Duman M. Are cytokines and cortisol important predictors for the severity of pediatric croup: A case control study. Turk J Pediatr 2017; 59: 281-287. The aim of this study is to investigate the role of cytokines (TNF-α, IL-6, IL-10, and PAF), cortisol, and IgE in the pathogenesis of croup and the factors determining its clinical severity. Patients diagnosed with croup at the Pediatric Emergency Department were included and thirty healthy children were included as a control group. Patients` demographic characteristics, clinical findings, recurrent croup history, and patient-family atopy history were recorded. Patients were grouped according to the Westley croup scoring system. Blood samples were taken from the control group and the patients for cytokines and cortisol. Respiratory pathogens were studied with PCR. Sixty-nine pediatric cases who were diagnosed as croup were included in the study (34 mild, 31 moderate, 4 severe). Group comparisons were made in terms of mild and moderate/severe groups. In the moderate/severe group, IL-10 and cortisol levels were higher than the mild group. The moderate/severe cortisol levels between 12:00 am-6:00 pm were found to be higher. PAF and TNF-alpha levels were detected to be higher in patients with a history of atopy. Viral agents were isolated in 45 patients; rhinovirus PCR tests were positive in 22 patients. In this study, rhinovirus was the most common etiology for croup. Increased levels of IL-10 and cortisol in the moderate/severe group indicate that different systemic and local mechanisms may play a role in the pathogenesis of croup.

Serum ECP and total IgE levels in children with acute laryngotracheobronchitis.

OBJECTIVE: Eosinophilic cationic protein (ECP) and immunoglobulin E (IgE) are important mediators of allergic inflammation and they are commonly used in the diagnosis and follow-up of allergic diseases. But serum levels of these molecules can also be elevated by some other diseases including viral infections. Acute laryngotracheobronchitis (ALTB) is an important viral infection of upper airway and serum levels of ECP and IgE may increase in patients with ALTB. METHODS: In the present study serum ECP and IgE levels were measured before treatment and on the third day and third week after treatment in 27 patients with ALTB aged 10 months to 5 years and were compared with a age matched healthy controls. All patients were treated with nebulized budesonide. RESULTS: We found that pre-treatment ECP levels were significantly higher than post-treatment third days and third weeks (28.3+/-2.3 ng/ml versus 20.2+/-3.2 ng/ml and 11.4+/-1.1 ng/ml, respectively). Similarly, the mean pre-treatment serum IgE values were significantly higher than post-treatment values (131.6+/-17.5 IU/ml versus 83.6+/-12.4 IU/ml and 68.2+/-6.7 IU/ml). A positive correlation was found between serum ECP and IgE values for pre-treatment and post-treatment third week values (r=062, p=0.01 and r=0.64, p=0.01, respectively). The pre-treatment serum ECP and IgE levels were significantly higher than those of controls (10.8+/-1.5 ng/ml and 43.8+/-6.6 IU/ml, respectively p<0.05). CONCLUSION: In this study it was shown that, serum ECP and IgE levels increase in the acute phase of infection and return to normal after treatment in patients with ALTB such as in allergic patients. This effect of ALTB on serum ECP and total IgE levels should be kept in mind and these parameters should not be used in the diagnosis and follow-up of allergic diseases in children who had had ALTB in recent weeks.

A randomized controlled trial of mist in the acute treatment of moderate croup.

OBJECTIVE: To determine whether the use of mist improves clinical symptoms in children presenting to the emergency department (ED) with moderate croup. METHODS: Children 3 months to 6 years of age were eligible for the study if they presented to the ED with moderate croup. Moderate croup was defined as a croup score of 2-7. The patients were randomly assigned to receive either mist (humidified oxygen) via mist stick or no mist. The patients had croup scores measured at baseline and every 30 minutes for up to two hours. At these intervals the following parameters were also measured: heart rate, respiratory rate, oxygen saturation, and patient comfort score. The patients were treated until the croup score was less than 2 or until two hours had elapsed. All patients initially received a dose of oral dexamethasone (0.6 mg/kg). Other treatments, such as racemic epinephrine or inhaled budesonide, were given at the discretion of the treating physician. The research assistants were unaware of the assigned treatments. RESULTS: There were 71 patients enrolled in the study; 35 received mist and 36 received no mist. The two treatment groups had similar characteristics at baseline. The median baseline croup score was 4 in both groups. The outcomes were measured as the change from baseline at 30, 60, 90, and 120 minutes. The change in the croup score from baseline in the mist group was not statistically different from the croup score change in the group that did not receive mist (p = 0.39). There was also no significant difference in improvement of oxygen saturation, heart rate, or respiratory rate at any of the assessment times. There was no adverse effect from the mist therapy. CONCLUSIONS: Mist therapy is not effective in improving clinical symptoms in children presenting to the ED with moderate croup.

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.

Inhalation of racemic adrenaline in the treatment of mild and moderately severe croup. Clinical symptom score and oxygen saturation measurements for evaluation of treatment effects.

The aim of this study was to evaluate the immediate effect of inhaling racemic adrenaline to treat croup and to evaluate a scoring system. Two groups were investigated. One group inhaled a racemic adrenaline solution and the other group received the same solution with no racemic adrenaline. The study was double-blinded and placebo-controlled. Fifty-four children (0.4-10.8 years) with mild to moderately severe croup were included in the study after clinical evaluation. The clinical score was useful when evaluating the treatment effects in mild to moderately severe croup and may be used as a quality assurance tool when treatment protocols are re-evaluated. Oxygen saturation before and after treatment did not change significantly in either group and therefore its measurement did not provide additional information on the effect of treatment. In both groups, a significant improvement in total mean clinical scores was seen 30 min after inhalation, compared with before inhalation (p < 0.001). However, racemic adrenaline was significantly better than placebo in terms of improvement in total clinical score, inspiratory stridor, retractions and air entry, and should therefore be used as first-line treatment.

Experience of pulse oximetry in children with croup.

We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.

[Immunoglobulins A, M, G, and E in children with acute viral respiratory diseases and the croup syndrome]. / Immunoglobuliny A, M, G i E u detei pri ostrykh virusnykh respiratornykh zabolevaniiakh s sindromom krupa.

Children with croup appearing in the presence of acute viral respiratory diseases (AVRD) show an increase in the IgM content in their blood sera during the first days of the disease followed by a decrease, and an increase in the IgG and IgE levels during the convalescence period. No essential shifts in the content of IgA have been observed. The total content of the immunoglobulins in children with croup, was lowered as compared to that in AVPD patients having no croup which is, probably, of a certain pathogenic importance. The increased content of IgE revealed in the blood sera of children with croup indicates the presence of an allergic component in this disease.

Indications for intubation in laryngotracheobronchitis in black children.

Fifty-eight children with laryngotracheobronchitis (LTB) were studied. Many were malnourished, or in the post-measles state, or had some lower respiratory tract or cardiac involvement. In these patients, factors helpful in assessing the need for relief of airway obstruction by tracheal intubation have been evaluated. A set of indications for intubation, which includes clinical and arterial blood gas features of LTB is suggested. Cognisance of complications of disease, where present, has also been taken. If cyanosis or muscular hypotonia or unawareness is present, intubation is urgently needed. When two of the following occur together, the need for intubation has arisen: (a) pulse rate greater than 170/min and respiratory rate greater than 55/min; (b) paCO2 greater than 37 mmHg; (c) paO2 less than 50 mmHg; and (d) a complication (cardiac failure or severe lower respiratory tract infection).