(1044) Management of Recurrent Croup: What Happens After Otolaryngology Consult?

Introduction: Croup is one of the most common pediatric respiratory illnesses; however, the natural course of recurrent croup is not well understood. The purpose of this study is to evaluate the natural course of recurrent croup in children and understand the impact of diagnostic and interventional procedures performed by otolaryngologists on the course of disease.

Methods: Data were obtained from a retrospective case series of children seen by a pediatric otolaryngologist at a tertiary academic children’s hospital clinic after three or more episodes of recurrent croup from January 2011 to January 2024. Data reviewed included medical treatment for recurrent croup, specialty consultations, comorbid diagnoses, and diagnostic or interventional procedures performed.

Results: In total, 25 pediatric patients (mean age of 18.8 months) with recurrent croup were identified. Subjects averaged 15.4 parent-reported episodes of croup and 7.4 ED visits. Treatment with high-dose dexamethasone was typical (89.7%). In recurrent episodes, most parents reported administering leftover corticosteroids rather than physician reevaluation and prescription. Microlaryngoscopy with bronchoscopy was performed for 88% of patients, of which 40.9% had a structural airway abnormality. Of the total, 20% had an interventional procedure (supraglottoplasty, balloon dilation). Croup-related ED visits decreased with ENT consult (4.4 [SD = 2.7] ED visits before vs 3 [SD = 3.5] after), initiation of inhaled corticosteroid treatment for asthma (4.7 [SD = 2.6] vs 2.9 [SD = 3.9]; 19 patients), and initiation of H2 blocker or PPI for GERD (3.7 [SD = 2.1] vs 1.4 [SD = 1.1]; 8 patients).

Conclusions: Children with recurrent croup were often treated at home through parent-administered high-dose steroids, raising concern for possible overuse. ED visits for croup decreased in similar fashion after otolaryngology consultation and initiation of inhaled steroids and/or treatment for GERD, suggesting that parental education, medical and/or surgical intervention, and the natural evolution of recurrent croup in children all may have roles in the resolution of recurrent croup.