The arrival of ómicron has given rise to a previously unrecognized complication of the Covid-19 virus in young children: laryngotracheobronchitis, also known as croup.
In the first peer-reviewed report to date, doctors from Boston Children’s Hospital in the United States describe 75 children who presented to the hospital emergency department with laryngotracheobronchitis and Covid-19 from March 1, 2020, to January 15. of 2022.
Some cases were surprisingly severe, requiring hospitalization and higher doses of medication compared to laryngotracheobronchitis caused by other viruses. Just over 80% were produced during the omicron period.
“There was a very clear delineation from when omicron became the dominant variant to when we started seeing an increase in the number of patients with laryngotracheobronchitis,” says Dr. Ryan Brewster, first author of the report, who It has been published in the scientific journal ‘Pediatrics’.
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Laryngotracheobronchitis, known medically as laryngotracheitis, is a common respiratory illness in infants and young children. It is characterized by a characteristic cough and a loud, sharp inhalation (known as stridor).
It occurs when colds and other viral infections cause inflammation and swelling around the larynx, trachea, and bronchi. In severe cases, including some seen at Boston Children’s, it can dangerously restrict breathing.
Studies of the Covid-19 virus in animals have found that the omicron strain has more “preference” for the upper respiratory tract than previous variants, which primarily targeted the lower respiratory tract. This may explain the sudden onset of laryngotracheobronchitis during the omicron surge, according to Brewster.
Consistent with the general pattern, the majority of children with COVID-19 and laryngotracheobronchitis were younger than 2 years of age, and 72 percent were boys. Except for one child with a common cold virus, none had a viral infection other than SARS-CoV-2.
Although no children died, nine of the 75 children with laryngotracheobronchitis associated with Covid-19 (12%) required hospitalization and four of them (44%, or 5% of the total) required intensive care. By comparison, before the virus, fewer than 5 percent of children with laryngotracheobronchitis were hospitalized, and of those, only 1 to 3 percent required intubation.
Overall, 97 percent of the children were treated with dexamethasone, a steroid. All those who were hospitalized received racemic epinephrine through a nebulizer, which is reserved for moderate or severe cases, as did 29 percent of the children treated in the ER. Those who were hospitalized required an average of six doses of dexamethasone and eight treatments of nebulized epinephrine to control their symptoms.
Who is affected? How is it treated?
The cause of croup is a virus. Most children have a single episode of croup, but a few have repeated episodes started by viral infections that gradually decrease in frequency and severity. The child has hoarseness and a frequent, strange-sounding cough that is described as metallic or barky. Croup varies widely in its severity, and it usually affects young children, under the age of 5.
“Most cases of laryngotracheobronchitis can be treated in the outpatient setting with dexamethasone and supportive care. The relatively high hospitalization rate and the large number of medication doses required by our COVID-19 laryngotracheobronchitis patients suggest that this virus could cause a more severe laryngotracheobronchitis compared to other viruses. Further research is needed to determine the best treatment options for these children,” Brewster said.
Experts recommend that the child be exposed to damp spaces, which is quickly achieved by leaving the hot water in the shower open to load the atmosphere with steam. Taking the child outside, to the window or the street, to breathe the cold night air, or to the kitchen to breathe cold air from the refrigerator also opens the respiratory tract. These remedies are harmless and there is little scientific evidence that they make any difference in the child’s progress, but improvement has been seen.