Acute Laryngo-Tracheo Bronchitis (Croup)

Introduction

Acute Laryngo-Tracheo bronchitis is a respiratory infection of the upper and lower tract affecting children 2-3 years of age.
It causes significant sub-glottic oedema
Most common aetiology is parainfluenza
virus infection preceded by an upper respiratory tract infection.

Symptoms and clinical features of Croup

  • Fever
  • Hoarseness
  • ‘Bovine cough’
  • Inspiratory stridor

Differential diagnosis

  • Acute epiglottitis

Complication of croup

  • Respiratory obstruction

Investigations

  • Radiograph of the neck (postero-anterior view)

Treatment for croup

Treatment objectives

  • Prevent asphyxiation
  • Treat inflammatory oedema

Supportive measures

  • Humidification
  • Hospitalization may be necessary

Drug treatment

Nebulized epinephrine

  • Child: 400 micrograms/kg (maximum 5 mg)
  • Repeat after 30 minutes if necessary

Glucocorticoids

  • Dexamethasone
    • Child 1 month -18 years: 10 – 100 micrograms/kg orally daily in 1 – 2 divided doses, adjusted according to response up to
      300 micrograms/kg daily especially in emergencies
    • Give parenterally in more severe cases
    • May repeat dose after 12 hours if necessary

Caution

  • Effects of nebulized epinephrine last 2 – 3 hours; the child should be monitored carefully for recurrence of the obstruction