Croup

Children with moderate to severe croup responding well to combination therapy with corticosteroids and nebulised epinephrine (adrenaline) (plus oxygen) may be safely discharged home after 2 to 4 hours of observation following epinephrine administration.

Children admitted to hospital with significant respiratory distress despite therapy require continuous monitoring and observation of respiratory status and vital signs.

In children who have undergone intubation, there is no need for subsequent follow-up after extubation, once the respiratory distress and symptoms of upper-airway obstruction have resolved.

The majority of children with croup are previously well and present with symptoms that are short-lasting and self-resolving. Recurrent croup is common with some children having repeated episodes over the course of months and years. However, there are occasional cases of children who have symptoms that merit further clinical evaluation to rule out airway pathology. These symptoms may include recurrent episodes that are particularly severe or frequent, croup symptoms that take an exceptionally long time to resolve, or most importantly, symptoms of airway obstruction that persist between episodes of acute infections. The goal of further investigations in these cases is to assess for uncommon underlying airway anomalies that could predispose the child to more severe airway narrowing during acute viral infections. Investigations that may be considered include airway endoscopy for airway visualization, radiographic imaging (lateral neck and chest radiograph, computed tomography or magnetic resonance imaging of the airway, or contrast assessment of the upper airway depending on the clinical situation), and pulmonary function testing.