Croup Research Articles

Intensive treatment of acute obstructive laryngitis in children

This paper addresses the specific challenges involved in the intensive treatment of acute obstructive laryngitis (OL) in young children by reviewing current literature, including both domestic and international publications. The analysis reveals that healthcare systems worldwide have significant experience in employing diverse pharmacological and non-pharmacological treatment approaches for this condition. According to the literature, the most effective treatments for OL in children are glucocorticoids and inhaled adrenaline, while there is no evidence supporting the use of oxygen therapy. The paper outlines the main routes of administration, considerations for dose selection, and potential side effects of the medications most frequently used in pediatric practice for OL. A comprehensive understanding of the specific aspects of intensive therapy in this medical emergency can significantly enhance the quality of care provided to pediatric patients.

Elaboration of selected respiratory system diseases in children in the pediatric hospital Bielsko-Biala In years 2015-2022.

Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In the youngest children, these diseases are caused by the structure of the respiratory tract, which is shorter and narrower than in an adult, as well as the immaturity of the immune system. Among all children under 5 years of age hospitalized due to respiratory diseases, 20% of cases are acute respiratory infections. The aim of the study is to discuss selected respiratory diseases in children aged 0-18 years hospitalized at the Pediatric Hospital in Bielsko-Biała. In June 2023, statistical data from the Pediatric Hospital was received regarding the number of hospitalized children aged 0-18 in 2015-2022. This article covers the following respiratory diseases: acute laryngitis, acute pharyngitis, pneumonia, bronchitis and bronchiolitis, bronchial asthma, adenoid hypertrophy and palatine tonsil hypertrophy coexisting with adenoid hypertrophy. Then, a table was prepared illustrating the trends of individual disease entities in the discussed time period. A total of 5,573 hospitalizations were analyzed for the period from 2015-2022. The largest group of children (1,583) were hospitalized due to acute bronchitis and bronchiolitis (28.41%), due to hypertrophy of the adenoid (1,093) and palatine tonsils (1,039), which is 19.6% and 18.64% respectively. The smallest number of children and adolescents were hospitalized due to acute laryngotracheitis (474) and pharyngitis (361), which is 8.51% and 6.47%, respectively, and due to asthma (54), which is 0.97%. It has been observed that from 2017 to 2022 the number of hospitalized patients is constantly increasing due to acute pharyngitis and pneumonia, and from 2018 to 2022 due to acute laryngotracheitis. In the analyzed Pediatric Hospital in Bielsko-Biała, the number of hospitalized children (from 0 to 18 years of age) due to pharyngitis, laryngotracheitis and pneumonia increased during the COVID-19 pandemic (2020-2022). The number of hospitalized patients due to pneumonia increased by as many as 70 from 2021 (197) to 2022 (267). In the case of hospitalizations for pharyngitis during the COVID-19 period, the number ranged from 46 in 2019 to 69 in 2022. Also in the case of acute laryngotracheitis in the period 2019-2022, the number of hospitalized young patients increases and ranges from 61 to 76. Respiratory tract infections are an important and common health problem for children. The vast majority of respiratory infections are caused by viruses.

Omówienie wybranych chorób układu oddechowego u dzieci na terenie szpitala pediatrycznego w Bielska-Białej w latach 2015-2022

INTRODUCTION. Respiratory tract infections in children are an interdisciplinary problem that pediatricians, allergists, laryngologists and immunologists encounter on a daily basis. In the youngest children, these diseases are caused by the structure of the respiratory tract, which is shorter and narrower than in an adult, as well as the immaturity of the immune system. Among all children under 5 years of age hospitalized due to respiratory diseases, 20% of cases are acute respiratory infections. OBJECTIVE. The aim of the study is to discuss selected respiratory diseases in children aged 0-18 years hospitalized at the Pediatric Hospital in Bielsko-Biała. MATERIAL AND METHODS. In June 2023, statistical data from the Pediatric Hospital was received regarding the number of hospitalized children aged 0-18 in 2015-2022. This article covers the following respiratory diseases: acute laryngitis, acute pharyngitis, pneumonia, bronchitis and bronchiolitis, bronchial asthma, adenoid hypertrophy and palatine tonsil hypertrophy coexisting with adenoid hypertrophy. Then, a table was prepared illustrating the trends of individual disease entities in the discussed time period. RESULTS. A total of 5,573 hospitalizations were analyzed for the period from 2015-2022. The largest group of children (1,583) were hospitalized due to acute bronchitis and bronchiolitis (28.41%), due to hypertrophy of the adenoid (1,093) and palatine tonsils (1,039), which is 19.6% and 18.64% respectively. The smallest number of children and adolescents were hospitalized due to acute laryngotracheitis (474) and pharyngitis (361), which is 8.51% and 6.47%, respectively, and due to asthma (54), which is 0.97%. It has been observed that from 2017 to 2022 the number of hospitalized patients is constantly increasing due to acute pharyngitis and pneumonia, and from 2018 to 2022 due to acute laryngotracheitis. CONCLUSIONS. In the analyzed Pediatric Hospital in Bielsko-Biała, the number of hospitalized children (from 0 to 18 years of age) due to pharyngitis, laryngotracheitis and pneumonia increased during the COVID-19 pandemic (2020-2022). The number of hospitalized patients due to pneumonia increased by as many as 70 from 2021 (197) to 2022 (267). In the case of hospitalizations for pharyngitis during the COVID-19 period, the number ranged from 46 in 2019 to 69 in 2022. Also in the case of acute laryngotracheitis in the period 2019-2022, the number of hospitalized young patients increases and ranges from 61 to 76. Respiratory tract infections are an important and common health problem for children. The vast majority of respiratory infections are caused by viruses.

Study on 25 (OH) Vitamin D Status in Hospitalizied Children with Acute Respiratory Infections: Preliminary Results

Summary Our study aimed to determine and analyze the serum levels of 25 (OH) vitamin D and parathyroid hormone (PTH) to assess vitamin D deficiency as a risk factor for increased morbidity of acute respiratory infections (ARI) in childhood. The changes in the serum parathormone level were used as a criterion for vitamin D sufficiency since an optimal level of 25 (OH) vitamin D is required for normal PTH values. The study included 87 children divided into four subgroups, respectively – children with acute bronchopneumonia (n=49), children with acute laryngotracheitis (n=11), children with acute bronchiolitis (n=16), and a control group (n=11). Subnormal Vit. D levels were found in the individual groups: in the bronchopneumonia group, 18 children showed evidence of insufficiency; in the group of children with laryngotracheitis, five children showed insufficiency, and one child had Vit.D deficiency; children with acute bronchiolitis showed abnormalities in vit. D levels: seven children with insufficiency and two children - with deficiency. The preliminary results showed that Vit. D status deviations are more common in children with acute respiratory infections than in healthy children.

Clinical and immunological characteristic of children with recurrent episodes of acute laryngotracheitis, acute respiratory infections, otorhinolaryngological deseases

Introduction. Researching on pathogenesis and immunopathogenesis of acute respiratory infections in conjunction with recurrent episodes of acute laryngotracheitis and otorhinolaringological diseases (tonsillopharyngitis, rhinosinusitis, otitis) — is a high priority task for pediatrics, what is necessary to do to create an approach for preventing chronic illnesses.The aim of the present work. Researching on clinical and immunological characteristics and efficiency of treatment with prescription of bacterial lysate (OM-85) for children with recurrent episodes of acute laryngotracheitis, acute respiratory infections (ARI), otorhinolaringological diseases.Materials and methods. Fifty children 3-9 years old (32 children 3-6 years, 18 children 7-9 years old; 32 boys, 28 girls) in the initial period of monitoring, with recurrent episodes of acute laryngotracheitis (ALT), acute respiratory infections (ARI), otorhinolaryngological diseases were examined. The treatment in according with pediatric clinical practice guidelines, consultations with a pediatrician, otorhinolaryngologist, allergologist were provided to all children.Twenty five children (subgroup I b) received bacterial lysate (OM-85, 4 courses in 3 years ) in complex treatment. Subgroups I a, I b were similar in clinical symptoms, gender and age related. Follow up period continued three years. The results were evaluated a year and three years after treatment. Experimental group was composed of 30 children 3-9 years old, additionally examined. This group had such characteristics as: frequency of acute respiratory infections 3-5 times in a year, absence of chronic respiratory diseases, of recurrent episodes of acute laryngotracheitis. Immunological survey included some parameters of innate immunity, serum immunoglobulins, chemiluminescence, interferons (IFN-alfa, IFN-gamma).Results. In children with repeated episodes of ALT and ARI and otorhinolaryngological diseases the expression of TLR2 and TLR4 on CD14+ cells, receptors for IFN-γ (CD14+CD119+) is significantly higher than in children without ALT and with a frequency of ARI 3-5 times a year, which is accompanied by a decrease in the level of IFN-γ and IFN-α and is associated with the development of dysregulation of the immune system, which decreases with the administration of bacterial lysate (OM-86). Complex treatment of children within 3 years with the prescription of the drug significantly reduces the frequency of ARI — 2.6 times, tonsillopharyngitis — 1.8 times, rhinosinusitis — 2.2 times, the need for the prescription of antibiotics — 2.2 times. In the group treated by standards after 3 years, the need for antibiotics decreased by 1.6 times, the frequency of ARI exacerbations — by 1.2 times, tonsillopharyngitis — by 1.5 times, rhinosinusitis — by 1.8 times.

A Rare Case of Acute Obstructive Laryngitis in a Cat with Severe Respiratory Distress

A Rare Case of Acute Obstructive Laryngitis in a Cat with Severe Respiratory Distress

Regional Experience in Improving the Quality and Cost-Effectiveness of Medical Care for Children with Acute Respiratory Pathology in the Rostov Region

One of the priorities of the modern world medical community is the continuous comprehensive improvement of medical care quality. Evaluation of medical care quality and material costs level for the management of patients with acute respiratory pathology (ARP) was performed in one city medical facility, as well as cost-effectiveness analysis of the project “Improvement of medical care quality for children of the Rostov region”. The first step of this study was retrospective audit of source medical records (n = 154) of Children’s hospital via the adapted World Health Organization questionnaire “Evaluation of in-patient care quality for children” recommended for Europe and revised in 2015. Inclusion criteria: hospitalization of patients with acute conditions; outcome — recovery with no complications; presence of one of the clinical manifestations (acute nasopharyngitis, acute non-obstructive bronchitis, acute obstructive bronchitis, acute obstructive laryngitis, acute community-acquired pneumonia). The cost-effectiveness evaluation was performed considering the direct treatment costs and the coefficient of economic costs per patient (CECPP). Analysis of the study’s first stage has revealed defects in medical care quality, significant and irrational material costs of the medical facility at all stages of medical and diagnostic care for children with ARP. CECPP peak indicators came under notice in all observation groups due to high expenses on medications and specifically those not included in clinical practice guidelines, vast amount of unreasonable hospitalizations and diagnostic procedures, expenses on physical therapy (PT), etc. Analysis of the study’s second stage medical records (n = 146) of patients with ARP took place after the initial audit followed by quarterly monitoring and hospital staff training (endpoint — 12 months). Significant improvements in the health care quality and cost-effectiveness for children with ARP have been shown.

The effectiveness of PCR-RT method for etiological diagnosis of atypical forms of whooping cough

The aim of the study was to evaluate the effectiveness of the PCR-RТ method using the PCR-RТ-IS test system for the etiological diagnosis of whooping cough in the examination of patients with infectious respiratory pathology with prolonged cough and in contact persons. 113 children aged from 1 month to 17 years, 11 months and 29 days, and 146 contact family members were examined. Regardless of the initial diagnosis, all children were examined for whooping cough by bacteriological, molecular genetic and serological methods. For molecular genetic diagnostics a commercial kit and PCR-RT-IS test-system developed at the Gamaleya Research Center were used. The contact persons were examined by the bacteriological method and using the PCR-RT-IS test-system. During the initial examination the diagnoses «Acute respiratory viral infectious», «Acute rhinopharyngitis», «Acute laryngotracheitis», «Acute bronchitis», «Pneumonia» were established. The severity of cough in contact persons was different – from a typical spastic «whooping cough» to complete absence of cough. By using the PCR-RT-IS test-system we developed, the DNA of pertussis pathogen was detected in groups of patients with «Acute rhinopharyngitis» in 34.4% of cases, «Acute laryngotracheitis» – in 64.3%, «Acute bronchitis» – in 69%, with a diagnosis of «Pneumonia» – in 33.3% of cases. In a number of cases combined course of whooping cough with respiratory infections (respiratory syncytial virus, rhinovirus and others) was detected. In the examined contact persons the causative agent of pertussis was detected using the PCR-RT-IS test-system in 51,4% of cases.

The risk of respiratory incidents in response to the increase of ozone concentration in the ambient air, in the Silesian Voivodeship, in 2016-2017.

Due to the high level of urbanization and industrialization, Silesian Voivodeship remains a region with the poorest quality ambient air, especially in the winter season in which alarm levels are constantly being exceeded. However, in the summertime, there are observed short-term episodes of high ozone concentrations for which their impact on the population health is poorly documented. The aim of the study was to assess the risk of daily respiratory health problems related to an increased pollutants concentration typical for photochemical smog. In the ecological type of study, secondary epidemiological data were used. They were obtained from the National Health Fund (NFZ) in Katowice and included the number of outpatient visits in primary health care and hospitalizations due to respiratory diseases (J00-J99) and selected acute respiratory incidents registered between 01/01/2016 and 31/08/2017 in the Silesian Voivodeship. In the summertime of both years (2016 and 2017), there were observed short-term episodes of photochemical smog in the study region. Obtained results show a significant increase in the risk of outpatient visits due to total respiratory diseases, and also due to acute pharyngitis, acute laryngotracheitis, bronchitis, and asthma in response to the increase in ozone concentration. Similarly, a significant increase in the risk of hospitalization for all respiratory diseases was found, however, it appeared with a delay of at least two to three weeks. In the case of hospitalization due to bronchitis statistically significant risk was observed 2-4 days after the increase in exposure. The occurrence of registered respiratory incidents was confirmed in response to the increase in ozone concentration, characteristic of the summertime in the Silesian Voivodeship.

Modern Approaches to the Management of Children with Acute Obstructive Laryngitis and Epiglottitis

Experts of the Union of Pediatricians of Russia have developed modern guidelines on the management of children with acute obstructive laryngitis and epiglottitis. Croup is the most common cause of acute upper respiratory obstruction in children aged from 6 months to 6 years. Usually respiratory viruses are the pathogenic agents of the disease. The etiological factor of epiglottitis is Haemophilus influenzae type b in the vast majority of cases (> 90%). However, nowadays, epiglottitis caused by this pathogen agent is more common in adults in countries with mass immunization against hemophilic infection. This article considers in detail etiology, pathogenesis, and classification issues. Special attention is given to diagnosis, differential diagnosis, and therapy (via evidence-based approach) of acute obstructive laryngitis in children.

Инородное тело верхних дыхательных путей у ребенка: клинический случай

Инородные тела верхних дыхательных путей продолжают оставаться одной из ведущих причин заболеваемости и смертности в раннем детском возрасте, при этом анамнестические данные и клиническая картина заболевания не всегда бывают специфичными для аспирации. В статье представлен клинический случай нетипичной картины инородного тела гортани у ребенка десяти месяцев. Анамнез заболевания и клиническая картина при поступлении ребенка в стационар не дали возможности заподозрить данный диагноз, и более суток ребенок получал лечение по поводу острого стенозирующего ларинготрахеита вирусной этиологии. В связи с неэффективностью лечения сделана попытка интубации трахеи, однако степень сужения просвета гортани вынудила произвести трахеостомию. Только в дальнейшем, при исследовании гортани с помощью фибробронхоскопа, было обнаружено твердое инородное тело в надсвязочном пространстве, проникающее между связками, оттесняющее правую голосовую связку латерально. После извлечения инородное тело было идентифицировано как осколок кости размером около 0,6 × 0,9 см. Таким образом, клиническая картина аспирации инородного тела может быть многообразной, неспецифичной и иногда далекой от классической. Учитывая способность данной патологии к маскировке, подозрение на аспирацию инородного тела, вероятно, должно возникать во всех случаях отсутствия эффекта от стандартной терапии какого-либо заболевания верхних или нижних дыхательных путей.

Outpatient Management of Acute Respiratory Infections in Children

Background. Antimicrobial resistance is one of the most crucial problems in human health care worldwide. The main cause of this crisis is the excessive and misuse of antibacterial drugs (ADs). The highest rate of improper antibiotics' prescriptions in pediatric practice is observed at treatment of respiratory tract infections in outpatient clinics.Objective. The aim of the study is to analyze the clinical practice of management of patients with acute respiratory infections (ARI) and the use of ADs in children's outpatient clinics across the regions of Russian Federation.Methods. Multicenter retrospective study was conducted. All ARI cases documented in 969 medical records (form 112/y) of children born in 2015–2017 yy. in 16 regions of Russian Federation (selected randomly) were analyzed.Results. Acute viral infection was diagnosed in 79.6% cases of referencing to doctor with ARI symptoms. Systemic ADs were prescribed in 23% cases of ARI. Antibacterial therapy was received by 14% of children diagnosed with acute respiratory viral infection, 35% with acute laryngotracheitis, 80% with acute bronchitis, 76% with acute rhinosinusitis, 94% with ARI associated with otitis media, 52% with tonsillopharyngitis, and 100% with community-acquired pneumonia. Amoxicillin (35%), amoxicillin/clavulanic acid (24%), azithromycin (20.2%) were prescribed most often. Parenteral administration of ADs was prescribed in 3.9% of cases, mostly for children with community-acquired pneumonia. Prescribed antibacterial therapy was unreasonable in 84% of analyzed cases. Polypragmasy occurred in 50.5% of cases. Clinical protocols violations were mostly common for management of patients with laryngotracheitis and tonsillopharyngitis.Conclusion. There is favorable trend towards the decrease in ADs prescribing frequency in outpatient clinics for children with ARI. Thus, polypragmasy and irrational choice of antibacterial therapy frequency remains quite high.

Коррекция метаболических нарушений при вторичном ацетонемическом синдроме в условиях острой респираторной вирусной инфекции у детей

Ацетонемический синдром (АС) — одно из самых частых метаболических нарушений у детей. Несмотря на большое количество работ, посвященных патогенезу гиперкетонемии, окончательно не выяснена роль процессов клеточного энергетического обмена в развитии данного состояния. Изучение энергетического баланса метаболизма позволяет выявить важные патогенетические звенья, прогностические критерии возникновения и течения АС, а также определить подходы к его коррекции. Проведено сравнительное контролируемое исследование среди 64 детей с вторичным АС на фоне воспалительных заболеваний респираторного тракта, в структуре которых определялись: острый ринофарингит, острый простой бронхит, острый стенозирующий ларинготрахеит, внебольничная пневмония, острый трахеит, острый обструктивный бронхит. В ходе работы определены значимые предикторы возникновения АС. Доказана статистически достоверная связь между уровнем ацетонурии и тяжестью состояния пациента. С целью коррекции АС применяли комплексный сбалансированный препарат Ионика у 36 детей основной группы. Применение глюкозосодержащего препарата Ионика позволило улучшить показатели активности ферментов энергообмена (СДГ, ЛДГ, ГФДГ, ГДГ), сократить длительность проявлений АС в основной группе, снизить необходимость в инфузионной терапии.

Management and referral of acute laryngotracheitis - Croup: The New South Wales Neonatal and Paediatric Emergency Transport Service experience.

To evaluate the experience of NETS (The Newborn and paediatric Emergency Transport Service) New South Wales (NSW) with children referred with a provisional diagnosis of croup. To examine the adherence of referral hospitals to NSW Health policy guidelines and to establish criteria for the need to transfer and the level of escort required for a child with croup to a higher level of care. A retrospective audit of all children with a provisional diagnosis of croup referred to NETS over the epoch: 2005-2015. The NETS database was searched for keywords: croup and laryngotracheitis. Demographics, retrieval characteristics and management strategies were collected. A total of 432 patients were identified. The number of children triaged to a medically led NETS team for transfer decreased (P< 0.001) whilst those transferred into more local regional or metropolitan hospitals (P< 0.001) increased. The number of adrenaline doses was not associated with intensive care admissions or the need for invasive ventilation. Medically led retrieval teams are not necessary for safe transfer of children with a provisional diagnosis of croup unless the airway is secured with an endotracheal tube. Transfer to more local hospitals for paediatric care should be considered and time allowed for medications to take effect prior to movement.

Croup

Croup

Characteristics Associated With Hospitalization for Croup

Characteristics Associated With Hospitalization for Croup

Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children.

Children's respiratory health are particularly vulnerable to outdoor air pollution, but evidence is lacking on the very acute effects of air pollution on the risk of acute upper respiratory infections (AURI) and acute lower respiratory infections (ALRI) in children. This study aimed to evaluate the risk of cause-specific AURI and ALRI, in children within 24h of exposure to air pollution. We obtained data on emergency cases, including 11,091 AURI cases (acute pharyngitis, acute tonsillitis, acute obstructive laryngitis and epiglottitis, and unspecified acute upper respiratory infections) and 11,401 ALRI cases (pneumonia, acute bronchitis, acute bronchiolitis, unspecified acute lower respiratory infection) in Brisbane, Australia, 2013-2015. A time-stratified case-crossover analysis was used to examine the hourly association of AURI and ALRI with high concentration (95th percentile) of four air pollutants (particulate matters with aerodynamic diameter <10μm (PM10) and <2.5μm (PM2.5), ozone (O3), nitrogen dioxide (NO2)). We observed increased risk of acute tonsillitis associated with PM2.5 within 13-24h (odds ratio (OR), 1.45; 95% confidence interval [CI], 1.02-2.06) and increased risk of unspecified acute upper respiratory infections related to O3 within 2-6h (OR, 1.38, 95%CI, 1.12-1.70), NO2 within 1h (OR, 1.19; 95%CI, 1.01-1.40), and PM2.5 within 7-12h (OR, 1.21; 95%CI, 1.02-1.43). Cold season and nigh-time air pollution has greater effects on AURI, whereas greater risk of ALRI was seen in warm season and daytime. Our findings suggest exposures to particulate and gaseous air pollution may transiently increase risk of AURI and ALRI in children within 24h. Prevention measures aimed at protecting children's respiratory health should consider the very acute effects of air pollution.

Interfacility Transfer Rates for Children with Croup, Asthma, and Gastroenteritis

Regionalization of care for children (i.e., sending more children to pediatric centers) is beneficial for those with some complex medical conditions,

Measles in the Child: Clinical Case

Background. Measles is a highly contagious viral infectious disease with airborne transmission. European countries has registered an increased incidence of measles during the period of 2018-2019 followed by the increased risk of epidemiological situation aggravation in Russia. Cases of measles in Russia are recorded mainly among unvaccinated persons who have refused to vaccinate, who have not been vaccinated due to medical contraindications and among homeless people. Clinical Case Description. Clinical case of the unvaccinated child with measles is presented. The disease had a severe course with a long-term fever, significant toxic syndrome and development of one of the most frequent complication — acute laryngotracheitis. Conclusion. The importance of implementation of prophylactic measures for prevention of measles emergence and spreading is specified, and the main approach is immunization of the population.

The effectiveness of local therapy of acute inflammatory diseases of the upper respiratory tract

To evaluate the efficacy of inhalation therapy with compressor nebulizer using Fluimucil Antibiotic IT in the treatment of ABRS and acute laryngotracheitis in outpatient practice. Patients with ABRS were divided into two sex- and age-matched groups of 26 people each. The first group was treated with 250 mg of Fluimucil Antibiotic IT inhalations by the use of Norditalia HI-NEB compressor nebulizer once a day. The second group was treated with amoxicillin/clavulanate 875 mg + 125 mg orally two times a day. In the first group, the cough disappeared significantly earlier (on day 5-6) than in the second group (on day 7-8). In the first group, nasal congestion also disappeared significantly earlier (on day 3-5) than in the second group (on day 4-6). There was no significant difference in the reduction of intoxication syndrome and nasal secretions in both groups. Local antibacterial and mucolytic therapy in the initial stages of ABRS and acute laryngotracheitis reduces rhinological symptoms and coughing, similar to systemic antibacterial therapy. The use of Fluimucil Antibiotic IT in the early stages of the treatment provides an opportunity to avoid systemic antibiotics, which reduces the risk of antibiotic resistance as well as side effects in patients.