Croup is a viral illness with inflammation of the upper airway. It is also known as acute viral laryngo-tracheo-bronchitis.
- Viral prodrome (1-2 days often mild corryzal symptoms)
- Harsh barking cough
- Hoarse voice and stridor
- Fever less than 38 degrees
- Stridor worse on crying and worse at night
- Sternal recession
- Tracheal tug
- Cyanosis on crying
- Continuous harsh sound
- Caused by obstruction in the larynx and trachea
- Predominantly an inspiratory noise
- Expiratory component may be present
- ? subglottic lesion
- Higher incidence in children than in adults (anatomical differences)
Differential diagnosis of stridor
- Acute laryngo-tracheo-bronchitis(croup)
- Acute epiglottitis
- Bacterial tracheitis
- Foreign body
- Acute angioneurotic oedema(anaphylaxis)
- Expanding mediastinal mass
- Peritonsillar or retropharyngeal abscess
Indicators of increasing severity necessitating admission are:
- Increasing respiratory rate
- Increasing stridor
- Diminished air entry on auscultation
- Cyanosis at rest with oxygen saturation of less than 95% in air
- Altered level of consciousness
- General supportive measures, gentle handling and reassurance
- Oral Dexamethasone (0.150 microgrammes /kg)
- Nebulised Budesonide( 2mg)[BestBets]
- Hydration should be assured by allowing the parents to feed the child
- Investigation should be kept to a minimum
- No lateral neck radiographs
Moderate to severe croup
- In the presence of increasing airway obstruction, it is imperative that the child is transferred to a paediatric facility
- Oxygen via either a nasal cannula or a face mask.
- Children often do not apply a face mask over their face but may well accept a mask held at a short distance above their face so that the oxygen plays across their nose and mouth.
- pre-existing narrowing of the upper airways (eg. subglottic stenosis congenital or 2° to neonatal ventilation) or
- children with Down Syndrome
- Nebulised Adrenaline[Epinephrine] (5mls of 1 in 1,000) under close supervision with cardiac monitor (Stop if pulse > 200 bpm) or nebulised budesonide [BestBets].
- If nebulised Adrenaline has been given, intravenous access should be obtained and the anaesthetic team contacted to review and admission arranged.
- Steroids prescribed should include either nebulised budesonide or oral prednisonone [BestBets].
- Contact anaesthetic and paediatric departments for advice.
are prone to more severe croup and admission should be considered even with mild symptoms