Croup

• What is croup?


  Upper respiratory tract infection -> oedema in larynx

  Most cases = viral cause

  Typically affects 6 months - 2 years
• What is the 'classical' cause of croup?

  Parainfluenza virus
• What are the possible causes of croup?

  Parainfluenza

  Influenza

  Adenovirus

  RSV
• Pathophys - croup


  Infection -> inflammation of subglottic & laryngeal mucosa -> partial obstruction of airways -> resp distress & stridor
• What are the signs & symptoms of croup?


  Prodromal phase of coryzal symptoms

  Increased work of breathing

  Barking cough

  Hoarse voice

  Stridor

  Drowsy & lethargic (severe)

  Low grade fever

  Red flags for resp failure:

  • Signs of resp distress
  • Cyanosis
  • Decreased level of consciousness
  • Decreased air entry on auscultation
  • Tachycardia
• What are the DDx of croup?


  Epiglottitis

  Bacterial tracheitis

  Foreign body aspiration

  Anaphylaxis
• What are the Inx for croup?

  DO NOT DISTRESS CHILD -> worsening symptoms & possible complete airway obstruction

  Clinical diagnosis

  Obs (if possible) -> to decide whether O2 is needed
• What are the possible complications of croup?


  Dehydration - due to poor fluid intake during illness

  Pneumonia - due to secondary bacterial infection

  Reps failure

  Death (rare)
• How long do symptoms of croup usually last?


  48 hours
• What is the classification of croup based on severity?

  Mild

  • barking cough, no stridor or recession at rest

  Moderate

  • barking cough w/stridor & recession at rest
  • no or little agitation/lethargy

  Severe

  • barking cough w/stridor & recession
  • agitation/lethargy present

  Impending resp failure

  • minimal barking cough, muffled stridor
  • increased recession + see-saw movement
  • decreased consciousness
  • tachycardia
• What is the treatment & management of croup?

  Most cases can be managed at home w/fluids & rest

  Stepwise options:

  Oral dexamethasone (usually single dose, 150 mcg/kg)

  O2

  Nebulised budesonide

  Nebulised adrenaline

  Intubation & ventilation
• When should hospital admission be considered in croup?

  Children with...

  • Stridor and/or sternal recession at rest
  • High fever
  • Respiratory rate > 60
  • Cyanosis
  • Lethargy or agitation
  • Fluid intake < 75% of normal or no wet nappies for 12 hours
  • Aged under 3 months
  • Chronic conditions such as immunodeficiency, chronic lung disease or neuromuscular disorders