Disease relevance of Croup

• In a 30-month prospective study of severe acute lower respiratory infections in hospitalized pre-school Nigerian children, acute bronchiolitis was diagnosed in 67 cases; 19 (28.4%) and 2 (3.0%) of these had concomitant pneumonia or croup, respectively [1].
• Unlike patients with croup, patients with bacterial tracheitis do not respond to aerosolized racemic epinephrine [2].
• METHODS: We conducted a double-blind trial at four pediatric emergency departments in which 720 children with mild croup were randomly assigned to receive one oral dose of either dexamethasone (0.6 mg per kilogram of body weight) or placebo [3].
• If there is difficulty in distinguishing between croup and epiglottitis, then chloramphenicol or ampicillin should be given [4].
• Patients with recurrent croup (n = 10) had a significantly higher degree of airway hyperreactivity and atopy than healthy children (n = 15), but significantly less than the patients with bronchial asthma (n = 30) [5].

High impact information on Croup

• A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup [6].
• CONCLUSIONS: In children with moderately severe croup, treatment with intramuscular dexamethasone or nebulized budesonide resulted in more rapid clinical improvement than did the administration of placebo, with dexamethasone offering the greatest improvement [6].
• As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01) [7].
• Many studies have attempted to find out whether steroid treatment is beneficial in children with croup, but the results have been inconclusive [8].
• Placebo-controlled trial of prednisolone in children intubated for croup [8].

Chemical compound and disease context of Croup

• We performed a prospective, blinded comparison of PP in children with croup versus healthy control subjects, analyzed the relationship between PP and Westley croup score (WCS), and observed the effect of racemic epinephrine (RE) on PP and WCS in a subgroup of patients with severe croup [9].
• There was no consistent response to isoproterenol inhalation among those who had had croup and normal subjects [10].
• In comparison to patients with upper respiratory illness alone, patients with croup had increased production of PV-specific IgE antibody, increased lymphoproliferative responses to PV antigen, and diminished histamine-induced suppression of lymphocyte transformation responses to PV [11].
• Sevoflurane for intubation of an infant with croup [12].
• Dexamethasone IM, or an equivalent dose of oral prednisone, may be considered in children with moderately severe croup who do not require hospitalization [13].

Biological context of Croup

• In children with croup, single 2 or 4mg dosages of budesonide inhalation suspension were significantly more effective than placebo and as effective as oral dexamethasone 0.6 mg/kg or nebulised L-epinephrine (adrenaline) 4mg in alleviating croup symptoms and preventing or reducing the duration of hospitalisation [14].
• The dexamethasone group had a lower frequency of stridor, Croup Score, and pulsus paradoxus measurement at 10 mins and at 6 and 12 hrs after extubation [15].
• Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Nebulised epinephrine or corticosteroids in croup [16].

Gene context of Croup

• With the exception of croup, all LRI were most common during February and March [17].
• The incidence of gastroesophageal reflux in recurrent croup [18].
• There was no association between croup in early life and markers of atopy measured during the school years [19].
• Pulmonary function and bronchial reactivity in children after croup [20].

Analytical, diagnostic and therapeutic context of Croup

• Racemic epinephrine in the treatment of croup: nebulization alone versus nebulization with intermittent positive pressure breathing [21].
• In a prospective investigation of 17 children with severe croup, we analyzed the effect of epinephrine inhalations and mild sedation with chloral hydrate on transcutaneous carbon dioxide pressure (tcPCO2), pulse oximetry measurements, and croup scores [22].
• PURPOSE: To determine if treating children who have acute, moderate croup with nebulized dexamethasone sodium phosphate in the emergency department results in clinical improvement by 4 hours and a decrease in the hospitalization rate [23].
• CONCLUSIONS: No statistical differences for any parameters were observed between intramuscular and oral dexamethasone treatments for children with moderate-to-severe croup at 24 hours or at any time the week after treatment [24].
• The objective of this study was to compare the efficacy of a single dose of oral dexamethasone of varying sizes in 120 children hospitalized with croup in two sequential double blind, randomized, controlled clinical trials (Trials A and B) [25].

References