ACUTE LARYNGOTRANCHEOBRONCHITIS

An acute inflammation of larynx, trachea and bronchi primarily in children < 3 years, usually viral.

Cause

  • Measles virus
  • Influenza and Parainfluenza type 1 viruses
  • Rarely – superinfection with bacteria e.g. H. influenzae

Note: Secondary bacterial infection is rare, therefore antibiotics are rarely needed

Clinical features

Early phase (mild croup)

  • Barking cough, hoarse voice or cry
  • Inspiratory stridor (abnormal high-pitched sound)
  • Common cold

Late phase (severe croup)

  • Severe dyspnoea and stridor at rest
  • Cyanosis (blue colour of child – especially extremities and mouth)
  • Asphyxia (suffocation)

Caution

  • Avoid throat examination. Gagging can cause acute obstruction

Management

Mild croup

  • Isolate patient, ensure plenty of rest
  • Keep well hydrated with oral fluids
    • Use oral rehydration solution
  • Give analgesics
  • Single dose steroid:
    • Prednisolone 1-2 mg/kg single dose
    • or Dexamethasone 0.15 mg/kg single dose

If condition is severe

  • Admit the patient
  • Ensure close supervision
  • Give humidified oxygen 30-40%
  • Keep well hydrated with IV fluids
  • Use Darrow’s solution ½ strength in glucose 2.5%
  • Steroids: hydrocortisone slow IV or IM
    Child <1 year: 25 mg
    Child 1-5 years: 50 mg
    Child 6-12 years: 100 mg

    • Or dexamethasone 300 micrograms/kg IM
  • Repeat steroid dose after 6 hours if necessary
  • If not controlled, nebulise adrenaline 0.4 mg/ kg (max 5 mg) diluted with normal saline, repeat
    after 30 min if necessary

If severe respiratory distress develops

  • Carry out nasotracheal intubation or tracheostomy if necessary
  • Admit to ICU or HDU

Suspect bacterial infection if child does not improve or appears critically ill

  • Treat as epiglottitis
Note
  • Avoid cough mixtures in children < 6 yrs

Prevention

  • Avoid contact with infected persons
  • Isolate infected persons