Recurrent croup presentation, diagnosis, and management

The lack of clinical insight into recurrent croup often leads to underdiagnosis of an upper airway lesion, and subsequently, inadequate treatment. This study examined the underlying etiology, diagnosis, treatment, and clinical outcome of patients with a history of recurrent croup identified at initial presentation. The aim was to present common diagnostic features and suggest new diagnostic and management recommendations.

A retrospective chart review of 17 children diagnosed with recurrent croup. Demographic, historical, and intraoperative data as noted in clinic charts were collected. Specific collected data included age, sex, chief complaint, presenting symptoms, past medical history, previous medication history, number of emergency room visits and inpatient admissions, tests/procedures performed and corresponding findings, current treatment given, and posttreatment clinical outcome.

Six (35.3%) patients presented initially with a past medical history of gastroesophageal reflux disease. Fourteen (82.3%) patients had positive endoscopic evidence of gastroesophageal reflux. For these 14 patients, 44 laryngopharyngeal reflux lesions were noted, with 32 (72.7%) occurring in the subglottis. All 14 patients demonstrated various degrees of subglottic stenosis ranging from 30% to 70% (Cotton-Myer grade I-II). All 17 patients (100%) demonstrated subglottic stenosis ranging from 15% to 70% airway narrowing.

History suggestive of recurrent croup requires close monitoring and expedient direct laryngoscopy/bronchoscopy for diagnosis. Long-term follow-up and antireflux treatment are necessary as well as endoscopic documentation of significant reflux resolution.