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Croup is a group of respiratory diseases that often affects infants under age 6. It is characterized by a barking cough; a whistling, obstructive sound (stridor) as the child breathes in; and hoarseness due to obstruction in the region of the larynx. It may be mild, moderate or severe, and severe cases, with breathing difficulty, can be fatal if not treated in a hospital.[1] Croup affects 5% of children in the second year of life; the peak incidence is between 7 and 36 months. The group of respiratory diseases consists of spasmotic croup, acute laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobronchopneumitis (LTBP), and laryngeal diptheria. LTB and LTBP, which usually involve a bacterial infection, are usually severe.[2]
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The routinely recommended treatment is with corticosteroids, although corticosteroids suppress the immune system and can predispose the child towards infection. There is a debate over how many doses to give, but Cherry in the New England Journal of Medicine recommends one dose, and has observed that children with viral, bacterial and fungal complications have had multiple doses. Epinephrine produces a significant reduction in the croup severity score but the benefit only lasts for 2 hours. Children with moderate or severe croup, with blood oxygen saturation under 92%, should receive oxygen.[6]
A traditional treatment for croup was humidified air. Often a parent would sit with a child in the bathroom and turn on a hot shower to generate steam. Although this had the advantage of giving parents the feeling that they were doing something useful, randomized, controlled trials reported by the Cochrane Collaboration[citation needed] and others have found that humidified air is not effective.[7]
Since laryngotracheitis is a viral disease (most commonly parainfluenza virus 1) antibiotics have no value. Croup can be prevented by immunization for influenza and diphtheria. At one time, croup referred to a diphtherial disease, but with vaccination diphtheria is rare.[8]
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