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Patients with croup often present with a "barky" cough, stridor, and trouble breathing, traditionally worse at night. The mainstay of treatment is a dose of dexamethasone and if there is moderate to severe distress, racemic epinephrine is added. Croup has typically been caused by viruses, mainly parainfluenza, but influenza, non-COVID coronavirus, adenovirus and RSV have also been shown to cause croup.
When COVID variant Omicron BA.1 became the dominant strain, the rate of pediatric emergency department visits and hospitalizations due to croup were noted to increase. This retrospective study of 499 pediatric patients showed that those who tested positive for COVID within one week of presentation had a significantly higher degree of stridor at rest, hypoxia, the need for additional doses of racemic epinephrine, admission to the floor, admission to the intensive care unit and increasing respiratory support.
Bottom line: Consider testing for COVID in your croup patient who is not responding to traditional therapies.
References
Scribner C, Patel K, Tunik M. Pediatric Croup Due to Omicron Infection Is More Severe Than Non-COVID Croup. Pediatr Emer Care 2022;00.