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New approaches to respiratory infections in children. Bronchiolitis and croup

Robert Bruce Wright1, Wendy J Pomerantz, Joseph W Luria

  • 1Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA. bruce.wright@chmcc.org

Emergency Medicine Clinics of North America
|February 6, 2002
PubMed

Insights

Croup, a common childhood respiratory illness, is often treated with supportive care. Steroids like dexamethasone improve outcomes for mild to moderate cases, while epinephrine can manage severe symptoms, potentially avoiding hospitalization.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Croup is a common viral respiratory illness in children under 6.
  • Parainfluenza viruses and RSV are frequent causes.
  • Initial home treatments like humidification are often insufficient for moderate to severe cases presenting to the Emergency Department (ED).

Purpose of the Study:

  • To outline current treatment strategies for croup in pediatric patients.
  • To highlight the efficacy of specific medications in managing croup symptoms.
  • To define criteria for safe discharge after ED treatment for severe croup.

Main Methods:

  • Review of established treatment protocols for viral croup.
  • Discussion of pharmacologic interventions including corticosteroids and epinephrine.
  • Analysis of observation periods and discharge criteria following acute treatment.

Main Results:

  • Oral dexamethasone (0.15-0.6 mg/kg) improves outpatient outcomes for mild to moderate croup, reducing hospitalizations.
  • Nebulized budesonide is an alternative steroid treatment.
  • Racemic or L-epinephrine effectively treats severe croup symptoms, allowing safe ED discharge after 3 hours of observation if asymptomatic.

Conclusions:

  • Corticosteroids are beneficial for mild to moderate croup.
  • Epinephrine administration in severe croup does not necessitate automatic hospitalization.
  • Careful observation and access to follow-up care enable safe discharge for severe croup patients post-treatment.

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