Abstract

Croup is one of the most common causes of upper airway obstruction in young children. Upper airway inflammation produced by a viral infection causes a barky cough, hoarse voice, inspiratory stridor, and respiratory discomfort. It causes upper airway blockage and must be distinguished from acute epiglottitis, bacterial tracheitis, or foreign body inhalation. Croup affects roughly 3% of children each year, mostly between the ages of 6 months and 3 years, and the parainfluenza virus is responsible for 75% of cases. Symptoms normally go away after 48 hours, but severe upper airway blockage might cause respiratory failure and arrest in rare cases. The degree of respiratory distress and accompanying findings must be the emphasis of the patient's examination. It is necessary to rule out the likelihood of foreign body aspiration and epiglottitis. The efficacy and safety of corticosteroids (intramuscular and oral dexamethasone), nebulized budesonide, oral prednisolone, heliox, humidification, and nebulized adrenaline are all investigated (racemate and L-adrenaline [epinephrine]). The provision of humidified air is the most crucial part of management. Children with moderate to severe croup benefit from racemic epinephrine and steroids. Children with restless stridor, tiredness, poisoning, or respiratory distress should be admitted. Active airway intervention is unusual, but if a blockage develops, it can save a life.

• 1.   Cherry, JD. Clinical practice.Croup.N Engl J Med 2008; 358:384.
• 2.   Bjornson, CL, Johnson, DW. Croup. Lancet 2008; 371:329.
• 3.   Segal, AO, Crighton, EJ, Moineddin, R, et al. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics 2005;116:51.
• 4.   Pruikkonen H, Dunder T, Renko M, et al. Risk factors for croup in children with recurrent respiratory infections: a case-control study. Paediatr Perinat Epidemiol 2009; 23:153.
• 5.   Weinberg GA, Hall CB, Iwane MK, et al. Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. J Pediatr 2009; 154:694.
• 6.   Frost HM, Robinson CC, Dominguez SR. Epidemiology and clinical presentation of parainfluenza type 4 in children: a 3-year comparative study to parainfluenza types 1-3. J Infect Dis 2014; 209:695.
• 7.   Sung JY, Lee HJ, Eun BW, et al. Role of human coronavirus NL63 in hospitalized children with croup. Pediatr Infect Dis J 2010; 29:822.
• 8.   Venn AMR, Schmidt JM, Mullan PC. Pediatric croup with COVID-19. Am J Emerg Med 2021; 43:287.e1.
• 9.   Van Bever, HP, Wieringa, MH, Weyler, JJ, et al. Croup and recurrent croup: their association with asthma and allergy. An epidemiological study on 5-8-year-old children. Eur J Pediatr 1999; 158:253.
• 10.   Cherry, JD. Croup (Laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobron chopneumonitis). In: Textbook of Pediatric Infectious Diseases, 6th ed, Feigin, RD, Cherry, JD, Demmler-Harrison, GJ, Kaplan, SL (Eds), Saunders, Philadelphia, 2009. p.
• 11.   Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health 2011; 47:77.
• 12.   Westley, CR, Cotton, EK, Brooks, JG. Nebulized racemic epinephrine by IPPPB for the treatment of croup: a double-blind study. Am J Dis Child 1978; 132:484.
• 13.   Yang WC, Hsu YL, Chen CY, et al. Initial radiographic tracheal ratio in predicting clinical outcomes in croup in children. Sci Rep 2019; 9:17893.

Data Sharing Statement

Funding