Are neck radiographs necessary in the management of croup syndrome?

Are neck radiographs necessary in the management of croup syndrome? Sir, A total of 115 children (83 boys and 32 girls) with croup syndrome were studied. Of these 110 had infective croup and five acute epiglottitis. The purpose of this study was to ascertain whether neck radiographs have any place in the diagnosis and management of croup syndrome in children. All except five with acute epiglottitis had chest and lateral neck radiographs on admission to hospital. Radiographs of 65 children, as expected, showed either ballooning of the hypopharynx or subglottic narrowing, or both, and no abnormality was found in the remaining 45 patients. The diagnosis of infective croup was mainly based on clinical presentation and acute epiglottitis was diagnosed on laryngoscopy. All children with acute epiglottitis required endotracheal intubation and all those with infective croup recovered with conservative management. Radiological findings of ballooning of the hypopharynx or subglottic narrowing did not help in the management of these children. If there is doubt about the diagnosis direct inspection is the only appropriate method, provided adequate precautions are taken to deal with an emergency. Furthermore, the handling necessary to obtain adequate radiographs of the neck may be very disturbing and may precipitate acute airways obstruction. It seems, therefore, that neck radiographs do not help in the management of croup syndrome in children. Danger of egg white treatment for nappy rash Sir, We wish to report a possible hazard of a commonly used remedy for nappy rash. A 6 month old boy, who at the age of 3 weeks had undergone bowel resection and afterwards developed lactose intolerance, was admitted to hospital for a lactose challenge. The challenge was unsuccessful and led to the development of profuse diarrhoea with acid stools. As a result he suffered severe excoriation of the buttocks which failed to respond to several proprietary preparations. A favourite nursing treatment for nappy rash was then instituted, applying egg white to the affected area and nursing exposed. After two days the baby developed a florid urticarial rash covering his whole body and became generally unwell. The egg white treatment was stopped and within 24 hours the rash had resolved and the baby's condition improved. Serum IgE measured at the time was 183 IU/ml (normal less than 11 IU/ml) and radio allergo-sorbent testing showed a class three response to egg. It is well recognised that eggs are highly allergenic and, in infants …