COVID-19 could cause croup in infants

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A research brief and a case report published in the last month have suggested a connection between croup and COVID-19 in infants.

Croup, one of numerous commonly treated pediatric infections found to have returned last winter and caused by the human parainfluenza viruses (HPIVs) is characterized by an infection of the upper airway which causes a harsh, repetitive, cough as a result of swelling around the larynx , trachea and bronchi.

A research brief and a case report published in the last month have suggested a connection between croup and COVID-19 in infants. Source: Adobe Stock

The case report, published last month in the Pediatric Infectious Disease Journal and written by researchers at Gazi University Hospital in Turkey, discussed a healthy 23-month-old child who suddenly had a fever and a “barking” cough, and was admitted to the hospital’s PICU. Tests for adenovirus, rhinovirus, influenza and others came back negative, but a nose swab for SARS-CoV-2 was positive.

“The patient was diagnosed with SARS-CoV-associated croup and was treated on the first day with 0.6 µmg/kg oral dexamethasone, inhaled adrenaline and had O2 saturation of 96% under 10L/min oxygen in a reservoir mask,” they wrote. “Since stridor and tachypnea continued 10 hours after the first dose of dexamethasone, a second dose of 0.6mg/kg dexamethasone and inhaled adrenaline treatment was given the next day. Noisy breathing and tachypnea resolved after 24 hours.”

The patient was discharged on the 3rd day of stay, the researchers said, and issues had resolved by the 7th day.

“We recommend that one of the causes of croup in children is COVID-19 and that COVID-19 should be added to the viral panel to determine the origin of croup,” they wrote. “We would also like to point out that COVID does not contribute to the severity of croup and may not be an indicator for complications such as [multi-system inflammatory syndrome in children].”

The research brief, published in Pediatrics and authored by researchers in the departments of general pediatrics at both Boston Children’s Hospital and Boston Medical Center, examined children diagnosed with COVID-19 with a recorded case of laryngotracheitis between March 1, 2020 and January 15, 2022

They found that 75 children diagnosed with COVID-19 associated croup, with 81% of the cases occurring during the dominance of the omicron variant and a sharp increase in December 2021. The median length of hospital stay was 1.7 days, during which time the patients were given dexamethasone and/or racemic epinephrine. The researchers also hypothesized that “the omicron variant causes laryngotracheobronchitis.”

“Two years into the COVID-19 pandemic, the pathogenicity, infectivity, and manifestations of new variants of SARS-CoV-2 have been dynamic and unique,” ​​they wrote. “Croup may represent yet another such novel presentation. Further research is needed to characterize the underlying mechanisms of COVID-19–associated croup, differences in clinical features from other viral etiologies, and appropriate management strategies in the SARS-CoV-2 era.”

References:

Brewster R, et al. Pediatrics. 2022; doi:10.1542/peds.2022-056492.

Dasdemir S, et al. Pediatr Infect Dis J.2021;doi:10.1097/INF.0000000000003565.

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