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Aerodigestive Approach in Evaluating Pediatric Patients With Recurrent Croup
Xiaoxuan Chen1, Nicola Pereira2, Katharina Graw-Panzer3
1Department of Otolaryngology-Head and Neck Surgery, and MD Program, Weill Cornell Medical College, New York, NY, USA.
Insights
Coordinated endoscopy involving multiple specialists aids in diagnosing recurrent croup in children. This approach identified common issues like bacterial infections and airway abnormalities, guiding management for persistent cases.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Gastroenterology
- Aerodigestive Medicine
Background:
- Recurrent croup presents a diagnostic challenge in pediatric patients.
- Effective management requires a multidisciplinary approach to identify underlying causes.
Purpose of the Study:
- To evaluate the effectiveness of coordinated endoscopy in diagnosing and managing recurrent croup in pediatric patients.
- To assess the diagnostic yield of a multidisciplinary endoscopic approach.
Main Methods:
- Retrospective review of the REDCap Pediatric Aerodigestive Database.
- Analysis of patients with recurrent croup who underwent coordinated endoscopy (January 2013 - July 2023).
- Review of patient demographics, comorbidities, endoscopic findings, treatments, and outcomes.
Main Results:
- Twenty-five pediatric patients with recurrent croup were identified.
- Common findings included positive bacterial cultures on bronchoalveolar lavage (BAL) (n=10), tracheomalacia (n=7), and subglottic stenosis (SGS) (n=4).
- Multiple abnormalities were identified in 48% of patients by at least two specialists.
Conclusions:
- A comprehensive aerodigestive evaluation is recommended for severe or frequent recurrent croup.
- Coordinated endoscopy is a valuable tool for select pediatric patients unresponsive to medical therapy.
Objective:
To evaluate the effectiveness of coordinated endoscopy with otolaryngology, pulmonology, and gastroenterology in diagnosing and managing recurrent croup in pediatric patients.
Methods:
We reviewed our REDCap Pediatric Aerodigestive Database for patients with recurrent croup who underwent coordinated endoscopy between January 2013 and July 2023. We reviewed patient demographics, comorbidities, surgical findings, treatments, and outcomes.
Results:
Twenty-five patients were identified with recurrent croup. Their mean (SD) age was 37 (27) months (range = 9-98 months) with half of the patients younger than 25 months. The most common findings noted on combined endoscopies were positive bacterial culture on BAL (n = 10), and tracheomalacia (n = 7), and subglottic stenosis (n = 4). A history of prematurity was significantly associated with the presence of SGS (p = 0.01). Snoring/sleep-disordered breathing (SDB) was associated with a positive bacterial BAL culture (p = 0.03). About half of our cohort (48%) had multiple abnormalities identified by at least 2 different specialists at the time of endoscopy.
Conclusions:
For patients experiencing frequent or severe recurrent croup episodes, a thorough aerodigestive evaluation and management plan should be pursued. Coordinated endoscopy may be considered for select patients who do not respond to medical treatment.
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