"The relatively high hospitalization rate and the large number of medication doses our COVID-19 croup patients required suggests that COVID-19 might cause more severe croup compared to other viruses," said study co-author Dr. Ryan Brewster, who is in the combined pediatrics residency program at Boston Children's Hospital and Boston medical Center.
"Further research is needed to determine the best treatment options for these children,” Brewster said in a Boston Children's Hospital news release.
In the paper, doctors described the cases of 75 children who went to Boston Children's Hospital's emergency department with croup and COVID-19 between March 1, 2020 and Jan. 15, 2022.
Croup is a common respiratory illness in babies and young children that occurs when colds and other viral infections cause inflammation and swelling around the voice box, windpipe and bronchial tubes. It is characterized by a distinctive barking cough and sometimes high-pitched intakes of breath (known as stridor). In severe cases, it can dangerously constrict breathing.
Most of the children in the study were under age 2, and 72% were boys. Except for one child with a common cold virus, none had a viral infection other than SARS-CoV-2.
"There was a very clear delineation from when Omicron became the dominant variant to when we started seeing a rise in the number of croup patients," Brewster said.
None of the children died, but nine (12%) were admitted to the hospital and four of those patients required intensive care.
Before COVID-19, fewer than 5% of children with croup were hospitalized, and only 1-3% of hospitalized patients required intubation, according to the study.
The steroid dexamethasone was given to 97% of the children in the study, and to 29% of those treated in the emergency department. All of those who were hospitalized received racemic epinephrine via nebulizer, which is reserved for moderate or severe cases of croup.
Hospitalized children required a median of six doses of dexamethasone and eight nebulized epinephrine treatments to control their croup symptoms — more than is usually needed for non-COVID croup.
The findings were published recently in the journal Pediatrics .
While mild croup can be treated at home with mist from a humidifier or steam from a hot shower, the study authors said parents should seek medical care if a child:
- Has frequent noisy inhalations and barking cough at rest
- Struggles to breathe
- Has increased fatigue or sleepiness
- Has blue lips or fingertips
- Has a temperature higher than 100.4°F for more than three days
- Has symptoms of mild croup lasting longer than seven days.
While many viruses can cause croup, parents should consider the possibility that their child has COVID-19 and think about having them and other family members tested, the authors suggested.
There's more on croup at the American Academy of Pediatrics.
SOURCE: Boston Children's Hospital, news release, March 15, 2022