Rebound stridor in children with croup after nebulised adrenaline: does it really exist?

Sakthivel, Muthukumar; Elkashif, Sami; Al Ansari, Khalid; Powell, Colin V.E.

Croup is characterised by a "barking" cough, hoarse voice, stridor and respiratory distress caused by generalised airway inflammation and oedema of the upper airway mucosa. Most children have mild illness which resolves spontaneously without any specific treatment. However, some children have severe illness with stridor, respiratory distress and hypoxaemia requiring intubation. Current evidence strongly supports the use of glucocorticoids for the management of croup [3] . Previously it was felt that steroids took up to 6 h to have an effect on the airway [4] , but a recent Cochrane review concluded that glucocorticoids improve croup symptoms at 2 h with the effect lasting at least 24 h [3] . Glucocorticoids also reduce rates of return visits, admissions and readmissions. When treated with placebo, 204 out of every 1000 children will return for medical care. When treated with glucocorticoids, 74-153 out of every 1000 children will return for medical care [3] . Glucocorticoids reduce the length of stay by 15 h (range 6-24 h), but make no difference to the need for additional treatments. Dexamethasone 0.15 mg·kg −1 or prednisolone 1 mg·kg −1 would be the recommended treatment dosing [2] , although other guidelines suggest doses up to 0.6 mg·kg −1 of dexamethasone [3] .