Acute Laryngo-Tracheobronchitis

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Laryngo-tracheobronchitis (croup) is acute inflammation of the larynx, trachea and bronchi which occurs in young children (usually between 6 months to 3 years of age). It arises as a result of narrowing of the airway in the region of the larynx. The most common cause is viral infection (particularly parainfluenza viruses) but may also be due to bacterial infection. The obstruction is due to inflammation and oedema.

Clinical presentation

  • The symptoms include paroxysmal “barking” cough, inspiratory stridor, fever, wheezing, hoarseness of voice and tachypnoea
  • Such symptoms usually occur at night
  • Respiratory failure and pneumonia are potentially fatal complications

Non-pharmacological Treatment

  • Prevent asphyxiation
  • Treat inflammatory oedema
  • Humidification of inhaled air
  • Hospitalization may be necessary

Note:

No stridor at rest, give no antibiotics

Stridor at rest, or chest in-drawing, or fast breathing REFER IMMEDIATELY to hospital

Mild Croup

  • Only stridor when upset, no moderate/severe ARI
  • Likely of viral origin
  • Home care - steam inhalation
  • Antibiotics NOT required

Severe Croup

  • Likely bacterial origin
  • Stridor in a calm child at rest
  • Chest in drawing
  • Antibiotics are NOT effective and should not be given

Pharmacological Treatment

Admit to hospital, give Oxygen therapy to all patients with chest in-drawing (using nasal prongs only, DO NOT use nasopharyngeal or nasal catheter) until the lower chest wall in-drawing is no longer present

D: dexamethasone (PO) 0.6mg/kg 24hourly in 1–2 divided doses

AND

A: adrenaline (inhalation) 400mcg/kg 2hourly if effective; repeat after 30min if necessary