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