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Croup. A current perspective
1Department of Pediatrics, University of Alberta, Edmonton, Canada.
Insights
Glucocorticoids effectively manage croup in children, reducing hospital admissions. Oral dexamethasone is recommended for its ease of use and cost-effectiveness in treating croup symptoms.
Area of Science:
- Pediatrics
- Emergency Medicine
- Pharmacology
Background:
- Croup management has advanced significantly over the past decade.
- Glucocorticoid use in croup has been linked to reduced healthcare utilization.
Purpose of the Study:
- To summarize current evidence on croup management.
- To provide guidance on the use of glucocorticoids and epinephrine in pediatric croup.
Main Methods:
- Review of existing evidence on croup management strategies.
- Analysis of treatment outcomes associated with glucocorticoids and epinephrine.
Main Results:
- Glucocorticoids are recommended for children with croup exhibiting increased work of breathing.
- Oral dexamethasone (0.15-0.6 mg/kg) is a preferred glucocorticoid due to accessibility and cost.
- L-Epinephrine or racemic epinephrine may be used for moderate to severe croup distress.
- Mist therapy lacks supporting evidence for croup treatment.
Conclusions:
- Glucocorticoids are a cornerstone of effective croup management.
- Oral dexamethasone offers a practical and cost-effective treatment option.
- Further research, including randomized controlled trials, is needed for mist therapy.
Abstract:
In the past decade, much progress has been made in the management of patients with croup. Where glucocorticoids have been adopted into practice, evidence shows that a decrease of health-care-service use is occurring in terms of fewer admissions to intensive care units and hospitals. The evidence may be summarized as follows. All children with croup symptoms who demonstrate increased work of breathing in the clinics or emergency departments should be treated with glucocorticoids. This treatment may be with nebulized budesonide (2 mg) or PO or IM dexamethasone (dose may be 0.15-0.6 mg/kg). Oral dexamethasone may be the best option because of its ease of administration, widespread availability, and lower cost. L-Epinephrine (5 mL of 1:1000) or racemic epinephrine (0.5 mL) should be considered for children with croup who have moderate or severe distress. No evidence supports the effectiveness of mist therapy, and physicians are in need of a randomized, controlled trial for this.