Acute Laryngo-Tracheo-Bronchitis (Croup)

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Introduction

  • An infection of the upper and lower respiratory tract affecting children 2 - 3 years of age
  • Causes significant sub-glottic oedema
  • Most common aetiology is parainfluenza virus infection preceded by an upper respiratory tract infection

Clinical features

  • Fever
  • Hoarseness
  • 'Bovine cough'
  • Inspiratory stridor

Differential diagnosis

  • Acute epiglottitis

Complication

  • Respiratory obstruction

Investigations

  • Radiograph of the neck (postero-anterior view)

Treatment objectives

  • Prevent asphyxiation
  • Treat inflammatory oedema

Supportive measures

  • Humidification
  • Hospitalization may be necessary

Drug treatment

Nebulized epinephrine

Child: 400 micrograms/kg (maximum 5 mg)

  • Repeat after 30 minutes if necessary

Glucocorticoids

Dexamethasone

  • Child 1 month -18 years:10 - 100 micrograms/kg orally daily in 1 - 2 divided doses, adjusted according to response up to 300 micrograms/kg daily especially in emergencies
    • Give parenterally in more severe cases
    • May repeat dose after 12 hours if necessary

Caution

  • Effects of nebulized epinephrine last 2 - 3 hours; the child should be monitored carefully for recurrence of the obstruction