Management of childhood croup.

Croup (laryngotracheobronchitis) is a common childhood croup in the home setting, particularly as the reduction in anxiety which both child and parent experience may be illness with a peak incidence of 60 per 1000 child-years in those aged between one and two years. 1 More severe cases clinically useful, but it should be recognised that this is almost certainly a placebo effect and there is no evidence of croup are traditionally observed in hospital in order to manage potentially life threatening airway obstruction. to support the continuing use of mist therapy in inpatient environments. Prior to the introduction of steroid therapy, intubation was required in approximately 2% of these hospitalised Corticosteroids were first advocated in croup in the 1950s, but a succession of clinical trials conducted over children. 2–4 When a previously well child presents with hoarseness, the ensuing 30 years failed to establish any clear benefit from their use. 11–20 In 1989 Kairys et al published a meta-barking cough and stridor, a diagnosis of croup is relatively straightforward. Children with a longstanding history of analysis of the nine methodologically satisfactory studies to date which had examined the use of steroid therapy in stridor or those under four months of age should be carefully evaluated for anatomical airway obstruction, such croup and concluded that there was a benefit from its use with a suggestion of a dose-response effect. 21 Six placebo as laryngeal cyst or papillomatosis, vocal cord paresis, extrinsic airway compression (e.g. vascular ring), or laryngo-controlled studies looking at the effect of steroids in children admitted to hospital with croup have since been tracheal stenosis. In children with high fevers and/or a toxic appearance, consideration should be given to more published and all have shown a clinically useful benefit, with improvements in clinical parameters, 10 22–26 duration serious infections such as bacterial tracheitis, retro-pharyngeal abscess, or epiglottitis. However, routine im-of hospital stay, 10 25 26 and requirement for " rescue " medication in the form of nebulised adrenaline. 10 None of these munisation against Haemophilus influenzae type b has dramatically reduced the incidence of invasive H influenzae trials had sufficient statistical power to demonstrate a reduction in the proportion of children who died or re-type b infection, so that epiglottitis is now a rare diagnosis in completely immunised children. 5 quired endotracheal intubation, both now comparatively rare outcomes. Steroids have, however, been shown to Croup has traditionally been divided …