COVID-19-Associated Croup in Children.

Abstract

As SARS-CoV-2 has evolved, so has its effects on the pediatric population.1 While early variants typically resulted in lower respiratory infections, the recently identified Omicron variant may exhibit a predilection for the upper airways.2 The relatively smaller upper respiratory tract in children compared to adults has been thought to predispose them to more severe clinical presentations resembling laryngotracheobronchitis, or croup. Caused by viral-induced subglottic airway inflammation, croup is classically characterized by sudden onset "barking cough", inspiratory stridor, and respiratory distress. Endemic coronaviruses have been linked to croup, however only sparse case reports have described croup specifically associated with SARS-CoV-2 and it remains unclear if croup cases constitute a causative relationship or result of co-infection with another virus.3-6 To address this knowledge gap, we performed a retrospective analysis of the incidence and clinical characteristics of croup associated with SARS-CoV-2 infection at a large freestanding children's hospital.