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Clinical Features and Outcomes of Omicron-Associated Croup in Children
Yue Huang1, Shuhua Su2, Zhengmin Xu1
1Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China.
Insights
Omicron variant infections can cause croup in children, typically with mild to moderate airway obstruction. Testing for other viral infections is not necessary, and prompt treatment can prevent severe outcomes and reduce hospitalizations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Croup, a common childhood respiratory illness, can be associated with various viral infections.
- The Omicron variant of coronavirus disease 2019 (COVID-19) has emerged as a potential cause of croup in pediatric populations.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of croup associated with the Omicron variant in children.
- To evaluate the necessity of co-viral infection testing in these cases.
Main Methods:
- A retrospective review of 105 children (aged 3-60 months) diagnosed with COVID-19 and croup between December 16-31, 2022.
- Analysis of clinical features, severity of laryngeal obstruction, treatment, and 8-month follow-up outcomes.
Main Results:
- Most children had mild to moderate laryngeal obstruction; 38.3% mild, 54.4% moderate, 6.7% severe.
- Croup developed 1-5 days after fever onset. Pneumonia was uncommon (9.5%).
- All patients recovered with nebulization and/or hormone therapy; hospitalization rate was 6.7%. Only 3.8% experienced recurrent croup during follow-up.
Conclusions:
- Omicron infection is a risk factor for pediatric croup, often presenting with manageable airway obstruction.
- Co-viral infection testing is generally not indicated. Prompt treatment can avoid unnecessary hospitalizations and healthcare costs.
Abstract:
Objective: This study was aimed to describe the clinical features and outcomes of Omicron-associated croup in children. Methods: A total of 105 children aged 3-60 months (median age 11 months) with coronavirus disease 2019 (COVID-19) and cough were admitted to our hospital from December 16, 2022, to December 31, 2022. Their clinical features, treatment, and outcomes were reviewed. These children were followed up for 8 months. Results: Among the cases, 5 had complex medical histories, while the other children were generally healthy. Out of the cases, 41 (38.3%), 57 (54.4%), and 7 (6.7%) had mild, moderate, and severe laryngeal obstruction, respectively. They developed croup after 1-5 days of fever (median 2 days). The majority (90.5%) of COVID-19 children with croup did not have pneumonia, and most of them (64.8%) had decreased eosinophil counts. Additionally, most other blood routine indicators were normal. Five other viral infections (chlamydia pneumoniae, respiratory syncytial virus, adenovirus, coxsackie virus, and mycoplasma pneumoniae) were tested in 51 cases, and all results were negative. All cases recovered from croup after receiving prompt nebulization therapy and/or intravenous drip of hormone. The hospitalization rate was 6.7%. During the 8-month follow-up period, 71 cases experienced repeated fever due to various infections, but only 4 cases (4/105, 3.8%) had repeated croup. Conclusion: Omicron is a risk factor for croup, with most cases presenting mild to moderate laryngeal obstructions. Co-viral infection testing is unnecessary for such cases. The symptoms of Omicron-associated croup may be more severe than croup associated with other viruses; however, unnecessary hospitalizations can be avoided, leading to reduced healthcare expenses.
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