Key Guidelines and Evidence

Guidelines:

• Croup in Children (American Academy of Pediatrics, 2018)
• Croup (Alberta Clinical Practice Guidelines, 2008)

Croup in Children (2018) Recommendations:

• Nebulized epinephrine for moderate-severe croup with stridor (Level 1A, Strong)
• Dexamethasone 0.6 mg/kg PO/IM/IV for moderate-severe croup (Level 1A, Strong)
• Dexamethasone 0.15-0.6 mg/kg PO for mild croup (Level 2B, Weak)

Landmark Trials:

• Westley et al., 1978: Demonstrated efficacy of nebulized racemic epinephrine in reducing croup scores and respiratory distress rapidly but temporarily.
• Bjornson et al., 2004: Showed single dose oral dexamethasone decreases length of stay and need for additional interventions compared to placebo in mild croup.
• Klassen et al., 1998: Oral dexamethasone may be superior to inhaled budesonide in preventing symptom recurrence.