croup (laryngotracheobronchitis)

Introduction

Acute upper airway obstruction in infants & children.

Etiology

• parainfluenza viruses 1 & 2

Clinical manifestations

• barking cough
• stridor
• nasal congestion
• difficult & noisy respiration
• cyanosis
• generally resolves within 1 day in 50% of children & within 2 days in 80% of children

Radiology

• neck radiograph, AP & lateral
  • unnecessary when the clinical suspicion for croup is high
  • subglottic narrowing ("steeple sign")

Management

• dexamethasone
  • 0.6 mg/kg PO (max 10 mg) single dose
  • 160 ug nebulized is less effective than oral dose
  • NNT = 5
• nebulized epinephrine if dexamethasone is needed
• endotracheal intubation or tracheostomy if needed
• humidity of no benefit

More general terms

• laryngitis
• tracheitis
• bronchitis