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Pediatric croup with COVID-19.

April M R Venn1, James M Schmidt2, Paul C Mullan2

  • 1Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, 630 W. 168th St, New York, NY 10032, USA.

The American Journal of Emergency Medicine
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PubMed
Summary

Three children developed croup, a respiratory illness, due to SARS-CoV-2 infection. This "COVID-19 croup" caused prolonged symptoms and required intensive treatment, unlike typical croup cases.

Keywords:
COVID-19CroupEmergency departmentPediatricSevere acute respiratory syndrome coronavirus 2Stridor

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Respiratory Medicine

Background:

  • Croup is a common pediatric respiratory illness, typically caused by viral infections.
  • Standard croup management includes racemic epinephrine and corticosteroids.
  • The emergence of SARS-CoV-2 has led to diverse clinical manifestations in children.

Observation:

  • Three previously healthy children presented with symptoms of upper-respiratory-tract infection, progressing to croup.
  • Clinical presentation included barky cough, stridor at rest, and respiratory distress.
  • Nasopharyngeal polymerase chain reaction testing confirmed SARS-CoV-2 infection in all three cases.

Findings:

  • These cases represent the first documented instances of croup as a manifestation of SARS-CoV-2.
  • Patients required multiple doses of racemic epinephrine with minimal response and experienced prolonged resolution of stridor (13-21 hours).
  • All patients received early dexamethasone, with at least one additional dose administered due to persistent symptoms; one child required intensive care.

Implications:

  • Testing for SARS-CoV-2 should be considered in children presenting with croup, especially given the potential for prolonged illness and quarantine requirements.
  • COVID-19 croup may present with significant pathology and a slower recovery compared to typical croup.
  • This highlights the need to consider novel etiologies for common pediatric conditions during the COVID-19 pandemic.