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The management of recurrent croup in children

Published online by Cambridge University Press:  02 April 2013

I Rankin ,
S M Wang ,
A Waters ,
W A Clement  and
H Kubba
I Rankin
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
S M Wang
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
A Waters
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
W A Clement
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
H Kubba*
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
*
Address for correspondence: Mr H Kubba, Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK Fax: +44 (0)141 2010865 E-mail: hkubba@nhs.net
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Abstract

Objective:

To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup.

Method:

Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011.

Results:

Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group.

Conclusion:

Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.

Keywords

CroupAcquired Subglottic StenosisCongenital Subglottic StenosisGastroesophageal RefluxBronchoscopyLaryngoscopy

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 5 , May 2013 , pp. 494 - 500
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

Presented orally at the Annual Summer Meeting of the Scottish Otolaryngological Society, 10 May 2012, Dunblane, Scotland, UK, and at the 11th International Congress of the European Society of Pediatric Otorhinolaryngology (ESPO 2012), 20–23 May 2012, Amsterdam, the Netherlands.

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