title: The management of recurrent croup in children.
abstract: OBJECTIVE
  To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup.
  
  
  METHODS
  Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011.
  
  
  RESULTS
  Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group.
  
  
  CONCLUSIONS
  Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.
authors.affiliation: Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK.
authors.forename: I
authors.initials: I
authors.lastname: Rankin
authors.forename: S M
authors.initials: SM
authors.lastname: Wang
authors.forename: A
authors.initials: A
authors.lastname: Waters
authors.forename: W A
authors.initials: WA
authors.lastname: Clement
authors.forename: H
authors.initials: H
authors.lastname: Kubba
mesh_terms: D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies