Glucocorticoids for croup in children

Outcomes of croup in children: COVID‐19 versus non‐COVID‐19 cases

“…[15][16] However, COVID-19 worsens the severity, 9,[12][13][14]22,20,23 Dexamethasone, usually administered to mild croup to mitigate inflammation, and RE for moderate to severe cases [10][11]24 may need to be administered more frequently in light of the greater severity of COVID-19 related croup. 9,[12][13][14]25 In 1 series, patients with COVID croup needed more than 2 RE treatments and more than 1 dose of dexamethasone. 9 Other studies have shown that multiple doses of RE are often required in these croup patients.…”

“…Dexamethasone, usually administered to mild croup to mitigate inflammation, and RE for moderate to severe cases 10–11,24 may need to be administered more frequently in light of the greater severity of COVID‐19 related croup 9,12–14,25 . In 1 series, patients with COVID croup needed more than 2 RE treatments and more than 1 dose of dexamethasone 9 .…”

Use of corticosteroids for croup in children

“…Although croup is a self-limiting illness, the significant benefit of corticosteroids is well documented 11. A recent Cochrane review of 45 randomised controlled trials conducted between 1964 and 2021, involving 5888 children with croup, was published in 2023 7. Notably, this does not discuss children with croup secondary to SARS-CoV-2 7.…”

“…Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission 1 6. Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net 2 7. It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care 3–6 8.…”

“…The above vignette outlines a presentation of moderate-to-severe croup, with the parents’ expectations reflecting the outcomes that we aspire to achieve as clinicians. However, current practice often differs between hospitals, with different formulations and strengths of corticosteroids being used 7 11 12. This Medicines Update aims to explore recent evidence around the optimal utility of corticosteroids for croup and demonstrate an evidence-based approach to achieving the best clinical outcomes for the child and their family.…”