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Home » , , » Croup
Croup
Monday, October 3, 2011 Posted by Piscean


Croup
Croup (acute laryngotracheobronchitis) presents with a coryzal prodrome, hoarseness (or husky voice in those old enough to speak), biphasic stridor, a harsh barking 'brassy' cough and variable airway obstruction due to inflammatory oedema within the subglottis. It is most common in 1 to 3 year old children and is generally self-limiting, with a duration of 2 to 5 days. Parainfluenza viruses are the most common cause of croup, and antibiotics are not indicated.

A flow-chart for assessment and management of croup is at Figure 14.17.
In mild cases (eg a croupy cough but no history of noisy breathing in a child older than 2 years), no treatment is necessary, but early review is essential.

In moderate to severe cases (eg a history of noisy breathing, or age less than 2 years, or the presence of stridor on examination), a single dose of corticosteroid is indicated. Various regimens have been employed. The most commonly used are:

1
dexamethasone 0.15 mg/kg orally

OR
1
prednisolone 1 mg/kg orally.
Further doses are usually not required, but can be considered if response to therapy is suboptimal at 24 hours. Inhalation of humidified air provides no (additional) benefit. Failure to respond may also be due rarely to bacterial tracheitis.

In more severe cases with significant airway obstruction or fatigue, treatment in hospital may be required with an initial dose of:
adrenaline 0.1% (1:1000, 1 mg/mL) solution 5 mL, by nebuliser

PLUS EITHER
1
dexamethasone 0.15 mg/kg orally (or IM if vomiting) [Note 1]

OR
1
prednisolone 1 mg/kg orally.
Maintenance dose and frequency vary with the severity of the condition and the response to treatment. Hydrocortisone should not be used due to lack of evidence and short duration of action.
Note 1: An oral dexamethasone paediatric formulation is only available in Australia as an extemporaneous preparation in or from specialised paediatric hospitals. Oral prednisolone solution is now available commercially in a palatable formulation.

Piscean

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