Croup

BackgroundThe clinical relevance of infections with the novel human coronavirus NL63 (HCoV-NL63) has not been investigated systematically. We therefore determined its association with disease in young children with lower respiratory tract infection (LRTI).Methods and findingsNine hundred forty-nine samples of nasopharyngeal secretions from children under 3 y of age with LRTIs were analysed by a quantitative HCoV-NL63-specific real-time PCR. The samples had been collected from hospitalised patients and outpatients from December 1999 to October 2001 in four different regions in Germany as part of the prospective population-based PRI.DE study and analysed for RNA from respiratory viruses. Forty-nine samples (5.2%), mainly derived from the winter season, were positive for HCoV-NL63 RNA. The viral RNA was more prevalent in samples from outpatients (7.9%) than from hospitalised patients (3.2%, p = 0.003), and co-infection with either respiratory syncytial virus or parainfluenza virus 3 was observed frequently. Samples in which only HCoV-NL63 RNA could be detected had a significantly higher viral load than samples containing additional respiratory viruses (median 2.1 x 10(6) versus 2.7 x 10(2) copies/ml, p = 0.0006). A strong association with croup was apparent: 43% of the HCoV-NL63-positive patients with high HCoV-NL63 load and absence of co-infection suffered from croup, compared to 6% in the HCoV-NL63-negative group, p ConclusionHCoV-NL63 infections occur frequently in young children with LRTI and show a strong association with croup, suggesting a causal relationship.

BackgroundStories may be an effective tool to communicate with and influence patients because of their ability to engage the reader. The objective of this paper is to describe the development of a story-based intervention for delivery of health evidence to parents of children with croup for use in a randomized controlled trial.MethodsA creative writer interviewed parents of children with croup presenting to the pediatric emergency department (ED) and drafted stories. We revised the stories based on written participant feedback and edited the stories to incorporate research evidence and health information. An illustrator and graphic designer developed story booklets which were evaluated through focus groups.ResultsTen participants provided feedback on the five stories drafted by the creative writer. Participants liked the concept but found the writing overly sophisticated and wanted more character development and more medical/health information. Participants highlighted specific story content that they liked and disliked. The revised stories were evaluated through focus groups involving eight individuals. Feedback was generally positive; one participant questioned the associated costs. Participants liked the graphics and layout; felt that they could identify with the stories; and felt that it was easier to get information compared to a standard medical information sheet. Participants provided feedback on the story content, errors and inconsistencies, and preferences of writing style and booklet format. Feedback on how to package the stories was provided by attendees at a national meeting of pediatric emergency researchers.ConclusionsSeveral challenges arose during the development of the stories including: staying true to the story versus being evidence based; addressing the use of the internet by consumers as a source of health information; balancing the need to be comprehensive and widely applicable while being succinct; considerations such as story length, reading level, narrative mode, representation of different demographics and illness experiences, graphics and layout. The process was greatly informed by feedback from the end-user group. This allowed us to shape our products to ensure accuracy, credibility, and relevance. Our experience is valuable for further work in the area of stories and narratives, as well as more broadly for identifying and developing communication strategies for healthcare consumers.

BackgroundHuman Parainfluenza Virus (hPIV) causes severe respiratory illness in infants and adults. Our study describes the association of hPIV1-4 with bronchiolitis, croup, and pneumonia using retrospective laboratory, administrative and public health data. Due to issues including the historic lack of hPIV4 in some commercial respiratory virus panels, the description of the impact of hPIV4 on croup, bronchiolitis, and pneumonia at population levels has often been limited. This study will use routine clinical laboratory data, and administrative data to provide a preliminary description of the impact of hPIV4 on these diseases in our population.MethodsA three year cohort of patients positive for hPIV was linked with data from physician visits and hospital admissions to define cases and hospitalization status. International Classification of Disease (ICD-9) codes were used to determine if cases had croup, bronchiolitis, and pneumonia. We also looked at differences in hospitalization status, age and gender among hPIV1-4. All statistical analysis was done using SPSS (Version 19.0.0, IBM Corp© 2010) and Graphpad Prism V6 (GraphPad Software, Inc., 2012).ResultsOnly hPIV1 and hPIV4 specimens had positivity rates greater than 5 % of all specimens sent for respiratory virus panel testing. hPIV1 exhibited a biennial pattern while the pattern for hPIV3 was less interpretable due to lower positivity rates. Circulation patterns for hPIV2 and hPIV4 were not assessed due to the low positivity rates of theses specimens. From 2010 to 2013, there were 2300 hPIV cases with hPIV3 (46 %) being the most common, followed by hPIV1 (27 %), hPIV4 (16 %) and hPIV2 (11 %). The median age was 2 years for all hPIV types. Males were slightly greater than females for hPIV1 and hPIV2, with an equal distribution for hPIV3 and slightly more females than males for hPIV4. hPIV1 and hPIV2 had the highest or proportion of croup while hPIV3 and hPIV4 had the highest proportion of pneumonia. Within hPIV4 cases, distributions of diseases were; pneumonia (21 %, 95 % CI 17.1-25.7), bronchiolitis (18 %, 95 % CI 14.3-22.5), croup (2 %, 95 % CI 0.8-3.9), mixed illness of any of pneumonia, bronchiolitis or croup (4 %, 95 % CI 2.5-7.0) or other respiratory diseases (54 %, 95 % CI 49.1-59.6).ConclusionsWe used laboratory and administrative data to undertake a descriptive analysis of the association of hPIV1-4 with croup, bronchiolitis and pneumonia. hPIV4 appears to be more associated more with bronchiolitis and pneumonia and less with croup in our population.

BACKGROUND: Croup is a common cause of upper respiratory tract obstruction in young children. Although most cases resolve spontaneously, some children experience recurrent attacks. Identifying prognostic factors that determine the risk of recurrence in children with recurrent croup may help optimize follow-up and treatment strategies. We aimed to investigate the clinical, demographic, and laboratory characteristics of children under six years of age with recurrent croup and to identify independent predictors of disease recurrence during a 6- and 12-month follow-up period. METHODS: We conducted a retrospective cohort study of 69 children (<6 years) diagnosed with recurrent croup at a single tertiary pediatric pulmonology and allergy–immunology center. Eligible subjects (≥2 clinician-documented episodes within 12 months) presented between October 2020 and October 2023 and had at least 12 months of follow-up. We gathered information from medical records about the children's background, health details, laboratory results, and treatments. Binary logistic regression was used to identify independent predictors of croup recurrence within the first 6 and 12 months. RESULTS: The mean age was 4.4±1.5 years, and 67% (n=46) were male. Within 6 months, 40.6% of cases experienced at least one recurrent attack, and 11.6% experienced a croup attack between 6 and 12 months. For 6-month recurrence, a family history of atopy (OR: 7.50, 95% CI: 1.96–28.68; p=0.003) and a higher number of croup attacks before follow-up (OR: 1.43, 95% CI: 1.06–1.92; p=0.020) were independent predictors, but age and cough trigger were not significant. For 12-month recurrence, family history of atopy (OR: 9.11, 95% CI: 1.12–74.00; p=0.039) and the number of attacks prior to follow-up (OR: 1.66, 95% CI: 1.08–2.54; p=0.020) were significant, while advanced age emerged as a protective factor (OR: 0.48, 95% CI: 0.24–0.95; p=0.035). In a small, clinically selected subgroup, flexible optical bronchoscopy and thoracic CT angiography identified airway compression and laryngeal findings possibly consistent with reflux-related irritation. CONCLUSIONS: In young children with recurrent croup, a family history of atopy and the number of prior croup episodes were independently associated with a higher probability of further recurrences during 6- and 12-month follow-up. These easily available clinical factors may help identify children who warrant closer follow-up, but validated risk thresholds and diagnostic pathways require prospective external validation.