Croup is a condition characterized by a bark-like cough, often caused by viral infections, particularly parainfluenza viruses, and is most common in children aged 3 months to 5 years. Treatment primarily involves airway management and steroids like dexamethasone, while nebulized epinephrine may be used for moderate to severe cases. Antibiotics are not indicated, and supportive care is key, as symptoms typically resolve within a week.

1. Abbas Wael Abbas
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2. croup refers to a heterogeneous group of
mainly acute and infectious processes that are
characterized by a bark- like or brassy cough
and may be associated with hoarseness,
inspiratory stridor, and respiratory distress
spasmodic or laryngotracheobronchitis
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3. Most common cause of upper airway acute
infection is virus , except ?
parainfuenza viruses (types 1, 2, and 3) 75% of
cases
Infuenza A is associated with severe
laryngotracheobronchitis
adenovirus, RSV , and measles
M.pneumoniae rare cause, mild
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4. Most patient between 3 mo and 5 yr, with the
peak in the 2nd yr of life
more common in boys
most commonly in the late fall and winter
15% of patients have a strong family history of
croup
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5. most common form of acute upper respiratory
obstruction
low-grade fever 1-3 days before the signs and
symptoms of upper airway obstruction become
apparent
rhinorrhea, pharyngitis, mild cough
barking cough, hoarseness, and inspiratory
stridor
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6.  child may prefer to sit up in bed or be held upright
 Symptoms are characteristically worse at night
And aggravated by agitation and crying
 resolve completely within a week
 Other family members might have mild respiratory
illnesses with laryngitis.
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7. hoarse voice
coryza
normal to moderately inflamed pharynx
 slightly increased respiratory rate
Rarely respiratory distress
alveolar gas exchange ?
 severe laryngotracheobronchitis is difficult to
differentiate from epiglottitis
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8.  children 1-3 yr of age
cause is allergic, psychologic. Viral in some cases
 similar to acute laryngotracheobronchitis, except?
 most commonly in the evening or nighttime, begins
suddenly
Child awake with a barking, metallic cough, noisy
inspiration, and respiratory distress
 symptoms generally diminishes within several
hours
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10. 1-33m-5y
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11. 15% of patient
middle ear, terminal bronchioles, or pulmonary
parenchyma infection .
Bacterial tracheitis
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14. The mainstay of treatment for children with
croup is airway management and treatment of
hypoxia
Most children with either acute spasmodic
croup or infectious croup can be managed
safely at home
observation showed cold night air is benefcial,
a Cochrane review has found no evidence
supporting
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15.  Beneficial in mild, moderate, sever if given in the
first 3 days
 single dose of 0.6 mg/ kg. a dose as low as 0.15
mg/kg may be just as effective
 oral dose of dexamethasone as effective as
intramuscular. Nebulized budesonide
 oral prednisolone is less effective
 adverse effect candida albican laryngotracheitis in
patient who received dexamethasone, 1 mg/ kg/24
hr, for 8 days.
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16. Nebulized racemic epinephrine is an
accepted treatment for moderate or severe
croup
decrease the laryngeal mucosal edema
dose of 0.25-0.5 mL of 2.25% racemic epineph-
rine in 3 mL of normal saline.
can be used as often as every 20 min
There is evidence that l-epinephrine (5 mL of
1:1,000 solution) is equally effective as
racemic epinephrine
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17.  Duration of activity < 2h
 observe 2-3 h then discharge
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18. Antibiotics are not indicated in croup.
Nonprescription cough and cold medications
should not be used in children < 4 yr
A helium-oxygen mixture (heliox) may be
considered in children with severe croup for
whom intubation is being considered
although the evidence is inconclusive
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19. progressive stridor
severe stridor at rest
 respiratory distress
hypoxia
cyanosis
depressed mental status
 poor oral intake
the need for reliable observation
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20. Does not require a radiograph of the neck
Steeple sign (PA)
Not specific
Does not correlate with disease activity
Considered after airway stabilization in
atypical presentation
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21. Thank you
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