Recurrent croup is a common clinical entity afflicting the pediatric population, but is not well-characterized in the literature. We describe the largest series of recurrent croup in North America from a single tertiary care academic center, and differentiate subpopulations based on demographic characteristics and clinical presentation. We identified 114 patients for inclusion. Common symptoms included barky cough (86.0%) and inspiratory stridor (60.5%). Many (26.3%) experienced full symptom resolution within a day, and 41.2% reported onset of symptoms at any time of the day. Male patients had a higher number of prior croup episodes at presentation compared with female patients (mean of 9.8 ± 8.0 in males vs 6.6 ± 4.8 in females, P = .03). On multivariate regression, racial/ethnic minority patients were at higher risk for dyspnea (odds ratio [OR]: 58.6; 95% confidence interval [CI]: 7.2-475.4) and upper respiratory infection prodrome (OR: 7.6; 95% CI: 1.6-35.3) compared with non-Hispanic white patients.
WorrallG.Croup. Can Fam Physician. 2008;54(4):573-574.
3.
BjornsonCLJohnsonDW.Croup in children. CMAJ. 2013;185(15):1317-1323. doi:10.1503/cmaj.121645.
4.
DennyFWMurphyTFClydeWAJrCollierAMHendersonFW.Croup: an 11-year study in a pediatric practice. Pediatrics. 1983;71(6):871-876.
5.
Kamali AghdamMShabani MirzaeeHEftekhariK. Croup is one of the clinical manifestations of novel coronavirus in children. Case Rep Pulmonol. 2021;2021:8877182. doi:10.1155/2021/8877182.
6.
OgraPL.Respiratory syncytial virus: the virus, the disease and the immune response. Paediatr Respir Rev. 2004;5(suppl A):S119-S126. doi:10.1016/s1526-0542(04)90023-1.
7.
PeltolaVHeikkinenTRuuskanenO.Clinical courses of croup caused by influenza and parainfluenza viruses. Pediatr Infect Dis J. 2002;21(1):76-78. doi:10.1097/00006454-200201000-00020.
8.
SmithDKMcDermottAJSullivanJF.Croup: diagnosis and management. Am Fam Physician. 2018;97(9):575-580.
9.
BjornsonCRussellKVandermeerBKlassenTPJohnsonDW.Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2013;10:Cd006619. doi:10.1002/14651858.CD006619.pub3.
10.
RittichierKK.The role of corticosteroids in the treatment of croup. Treat Respir Med. 2004;3(3):139-145. doi:10.2165/00151829-200403030-00002.
HodnettBLSimonsJPRieraKMMehtaDKMaguireRC.Objective endoscopic findings in patients with recurrent croup: 10-year retrospective analysis. Int J Pediatr Otorhinolaryngol. 2015;79(12):2343-2347. doi:10.1016/j.ijporl.2015.10.039.
13.
JabbourNParkerNPFinkelsteinMLanderTASidmanJD.Incidence of operative endoscopy findings in recurrent croup. Otolaryngol Head Neck Surg. 2011;144(4):596-601. doi:10.1177/0194599810393883.
14.
HiebertJCZhaoYDWillisEB.Bronchoscopy findings in recurrent croup: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2016;90:86-90. doi:10.1016/j.ijporl.2016.09.003.
15.
Van BeverHPWieringaMHWeylerJJNelenVJFortuinMVermeirePA.Croup and recurrent croup: their association with asthma and allergy. An epidemiological study on 5-8-year-old children. Eur J Pediatr. 1999;158(3):253-257. doi:10.1007/s004310051062.
16.
ArslanZCipeFEOzmenSKondolotMPiskinIEYöneyA.Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup. Pediatr Int. 2009;51(5):661-665. doi:10.1111/j.1442-200X.2009.02859.x.
17.
GreiferMSantiagoMTTsirilakisKChengJCSmithLP.Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach. Int J Pediatr Otorhinolaryngol. 2015;79(5):749-752. doi:10.1016/j.ijporl.2015.03.007.
18.
CooperTKuruvillaGPersadREl-HakimH.Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147(2):209-214. doi:10.1177/0194599812447758.
19.
WakiEYMadgyDNBelenkyWMGowerVC.The incidence of gastroesophageal reflux in recurrent croup. Int J Pediatr Otorhinolaryngol. 1995;32(3):223-232. doi:10.1016/0165-5876(95)01168-b.
20.
HoaMKingsleyELCoticchiaJM.Correlating the clinical course of recurrent croup with endoscopic findings: a retrospective observational study. Ann Otol Rhinol Laryngol. 2008;117(6):464-469. doi:10.1177/000348940811700610.
21.
KwongKHoaMCoticchiaJM.Recurrent croup presentation, diagnosis, and management. Am J Otolaryngol. 2007;28(6):401-407. doi:10.1016/j.amjoto.2006.11.013.
22.
FarmerTLWohlDL.Diagnosis of recurrent intermittent airway obstruction (“recurrent croup”) in children. Ann Otol Rhinol Laryngol. 2001;110(7, pt 1):600-605. doi:10.1177/000348940111000702.
23.
ChunRPreciadoDAZalzalGHShahRK.Utility of bronchoscopy for recurrent croup. Ann Otol Rhinol Laryngol. 2009;118(7):495-499. doi:10.1177/000348940911800707.
CoughranABalakrishnanKMaY, et al. The relationship between croup and gastroesophageal reflux: a systematic review and meta-analysis. Laryngoscope. 2021;131(1):209-217. doi:10.1002/lary.28544.
26.
ElbulukOShibaTShapiroNL.Laryngomalacia presenting as recurrent croup in an infant. Case Rep Otolaryngol. 2013;2013:649203. doi:10.1155/2013/649203.
27.
MunsonPD.Recurrent croup and persistent laryngomalacia: clinical resolution after supraglottoplasty. Int J Pediatr Otorhinolaryngol. 2016;84:94-96. doi:10.1016/j.ijporl.2016.02.035.
DaiXRyanMAClementsAC, et al. The effect of language barriers at discharge on pediatric adenotonsillectomy outcomes and healthcare contact. Ann Otol Rhinol Laryngol. 2021;130(7):833-839. doi:10.1177/0003489420980176.
30.
DudleyKAPatelSR.Disparities and genetic risk factors in obstructive sleep apnea. Sleep Med. 2016;18:96-102. doi:10.1016/j.sleep.2015.01.015.
31.
YiJSDavisACPietschK, et al. Demographic Differences in Clinical Presentation of Pediatric Paradoxical Vocal Fold Motion (PVFM) [published online ahead of print, 2021 Oct 9]. J Voice. 2021;S0892-1997(21)00295-2. doi:10.1016/j.jvoice.2021.08.017.
