Nebulized epinephrine for croup in children

Area of Science:

• Pediatrics
• Emergency Medicine
• Respiratory Medicine

Background:

• Croup is a common childhood respiratory illness causing barky cough, stridor, hoarseness, and distress.
• Severe croup cases may necessitate intubation.
• Nebulized epinephrine (NE) is a potential intervention to prevent intubation in children with croup.

Purpose of the Study:

• To evaluate the efficacy and safety of nebulized epinephrine (NE) in children presenting to the emergency department or hospitalized with croup.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and quasi-RCTs involving children with croup.
• Searched multiple databases including CENTRAL, MEDLINE, EMBASE, Web of Science, CINAHL, and Scopus.
• Primary outcome: change in croup score post-treatment; Secondary outcomes: intubation rates/duration, hospitalization, return visits, parental anxiety, and side effects.

Main Results:

• Eight studies with 225 participants were included.
• NE showed a significant improvement in croup scores at 30 minutes post-treatment (SMD -0.94; 95% CI -1.37 to -0.51), but this effect was not sustained at 2 or 6 hours.
• NE was associated with a significantly shorter hospital stay (mean difference -32.0 hours; 95% CI -59.1 to -4.9). No significant differences were found between racemic and L-epinephrine, or between IPPB and simple nebulization.

Conclusions:

• Nebulized epinephrine provides a clinically significant, albeit transient, reduction in croup symptoms within 30 minutes.
• Current evidence does not support a preference for racemic over L-epinephrine or for intermittent positive pressure breathing (IPPB) over simple nebulization.