From the Guidelines
Croup should be diagnosed and treated with a focus on reducing inflammation and alleviating symptoms, using a clinical guideline and orderset to minimize hospital admissions, as shown in a recent study published in Pediatrics 1. The diagnosis of croup is typically based on clinical presentation, including a barking cough, hoarseness, and stridor. For mild cases, home management with cool mist humidification and keeping the child calm is usually sufficient.
- Key symptoms to look out for include:
- Barking cough
- Hoarseness
- Stridor
- Respiratory distress
- For moderate to severe cases, treatment with a single dose of oral dexamethasone (0.15-0.6 mg/kg, maximum 10 mg) is recommended, as it reduces inflammation in the upper airway 1. In severe cases with respiratory distress, nebulized epinephrine (racemic epinephrine 2.25% solution, 0.5 mL in 2.5 mL normal saline, or L-epinephrine 1:1000,5 mL) may be needed in an emergency setting, followed by observation for at least 2-3 hours as symptoms can recur.
- The use of a clinical guideline and orderset, as implemented in the study published in Pediatrics 1, can help reduce hospital admissions for croup by standardizing treatment and ensuring that patients receive evidence-based care. The goal of treatment should be to reduce morbidity, mortality, and improve quality of life, and the use of a clinical guideline and orderset can help achieve this goal by minimizing hospital admissions and ensuring that patients receive timely and effective treatment 1.
From the Research
Diagnosis of Croup
- Croup is an acute clinical syndrome of childhood characterized by a barking cough, hoarse voice, stridor, and a variable degree of respiratory distress 2
- It is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough 3
- Laboratory studies are seldom needed for diagnosis of croup, and viral cultures and rapid antigen testing have minimal impact on management 3
- Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected 3
Treatment of Croup
- Corticosteroids are the primary treatment option for croup, and can be used in out-patient and in-patient settings 2, 4
- Oral dexamethasone 0.15 mg/kg or nebulised budesonide 2 mg are effective for mild to moderate croup 2
- In severe croup requiring intubation, oral prednisolone 1 mg/kg every 12 hours decreases the duration of intubation and the need for re-intubation 2
- Nebulized epinephrine provides effective additional therapy for more severe cases of croup 3, 5
- The use of humidified oxygen remains controversial, as good data are lacking 5
- Heliox may be effective in the short-term management of refractory croup, but limited data are available 5