PRESENTED BY:A.PRIYADHARSHINI M.Sc(N),LECTURER,JAI INSTITUTE OF NURSING AND RESEARCH,GWALIOR.
DEFINITION:Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway.
INCIDENCE:Childrens are affected between 3 months to 5 years of age with a peak during second year of life.The incidence is higher in males and can occur throughout the year with peaks in winter and late fall.There may be an associated family history.
ETIOLOGY:Viral causes:Viral agents are more commonly implicated.The parainfluenza virus type 1, 2 and 3 are the most common etiologies.Other viruses associated are influenza A and B, adenovirus, respiratory synctial virus (RSV), and Measles.
CLINICAL FEATURES:Initial symptoms- rhinnorhea, mild cough and low grade fever.“Barking" cough-The "barking" cough is often described as resembling the call of a seal or sea lion. Stridor- The stridor is worsened by crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. HoarsenessDifficult breathing which usually worsens at night.Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing.
Diagnostic evaluation: A frontal X-ray of the neck- it may show a characteristic narrowing of the trachea, called the steeple sign, because of the subglottic stenosis, which is similar to a steeple in shape. (inverted v shape)
CONTD..Nasopharyngeal aspirate- Viral cultureWBC CountClinical diagnosis doneOther investigations are excluded to prevent unnecessary agitation and thus improve the stress.
The Westley Score: Classification of croup severity Number of points assigned for this feature Feature 0 1 2 3 4 5Chest wall None Mild Moderate Severeretraction WithStridor None At rest agitation WithCyanosis None At rest agitationLevel of Normal Disorientedconsciousness MarkedlyAir entry Normal Decreased decreased
Scoring system:A total score of ≤ 2 indicates mild croup.A total score of 3–5 is classified as moderate croup.A total score of 6–11 is severe croup.A total score of ≥ 12 indicates impending respiratory failure.( The score ranges from 0-17)
TREATMENT:Supportive care including intravenous fluids to maintain hydration and oxygen inhalation to relieve hypoxia has to be given.A single dose of dexamethasone 0.6 mg/kg may decrease the severity and duration of illness.Inhalation of epinephrine may decrease the symptoms of stridor and respiratory distress immediately.Antibiotics are not usually indicated.
COMPLICATIONS:Extension of infectious process to other regions of the respiratory tract, e.g. middle ear or pulmonary parenchyma.Bacterial tracheitis
PREVENTION:Many cases of croup have been prevented by immunization for influenza and diphtheria.
PROGNOSIS:Viral croup is usually a self-limited disease, but can very rarely result in death from respiratory failure .Symptoms usually improve within two days, but may last for up to seven days.