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The management of recurrent croup in children
1Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK.
Insights
Recurrent croup in children often stems from airway abnormalities or reflux. Laryngobronchoscopy aids diagnosis, with reflux findings predicting treatment success, unlike clinical presentation alone.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Respiratory Medicine
- Pediatric Gastroenterology
Background:
- Recurrent croup presents a diagnostic challenge in pediatric care.
- Identifying underlying causes is crucial for effective management and improved outcomes.
Purpose of the Study:
- To investigate the causes, diagnostic methods, treatments, and outcomes for children experiencing recurrent croup.
- To evaluate the effectiveness of specific diagnostic tools and treatments for recurrent croup.
Main Methods:
- A retrospective review of medical records for children with recurrent croup was conducted.
- The study included patients referred to an otolaryngology service over a nine-year period.
Main Results:
- Anatomical airway abnormalities, including subglottic stenosis, were found in 28% of cases.
- Laryngobronchoscopy revealed reflux in 26% of children, with 91% responding well to anti-reflux medication.
- A significant portion (45%) had no identified cause, and this group had a higher likelihood of ongoing croup episodes and one death.
Conclusions:
- Airway anomalies are a frequent finding in children with recurrent croup.
- Laryngobronchoscopy is valuable for identifying causes and predicting prognosis.
- Reflux findings on laryngobronchoscopy, not clinical presentation, predicted positive response to anti-reflux treatment.
Objective:
To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup.
Method:
Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011.
Results:
Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group.
Conclusion:
Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.
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