Nebulized epinephrine for croup in children

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Illnesses
• Pharmacology

Background:

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

Purpose of the Study:

• To evaluate the efficacy of nebulized epinephrine versus placebo in children with croup.
• To assess safety, including side effects, of nebulized epinephrine.
• Key outcome measures included croup scores, intubation rates, and healthcare utilization (hospitalization).

Main Methods:

• Systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, Web of Science, CINAHL, Scopus) up to July 2013.
• Inclusion of randomized controlled trials (RCTs) and quasi-RCTs involving children with croup.
• Primary outcome: change in croup score; Secondary outcomes: intubation/hospitalization rates, return visits, parental anxiety, side effects.

Main Results:

• Eight studies with 225 participants (mostly under two years old, moderate to severe croup) were included.
• Nebulized epinephrine significantly improved croup scores at 30 minutes post-treatment (SMD -0.94; 95% CI -1.37 to -0.51).
• A significantly shorter hospital stay was observed with nebulized epinephrine compared to placebo (MD -32.0 hours; 95% CI -59.1 to -4.9).

Conclusions:

• Nebulized epinephrine provides a clinically significant, albeit transient, reduction in croup symptoms within 30 minutes.
• No significant differences were found favoring racemic epinephrine over L-epinephrine, or IPPB over simple nebulization.
• The small number of studies and participants limits definitive conclusions, highlighting the need for further research.