For Children Affected by Omicron Variant Causing "Croup"

A new study shows that the COVID-19 variant "Omicron" can cause croup in young children, including severe cases that require hospitalization and intensive care.

Although young children with COVID-19 disease generally experience mild illness, the Omicron variant has led to more hospitalizations with COVID-19 in recent months at a rate five times higher than the delta variant. All children included in the study were of ages less than five and not vaccinated.

The current Omicron wave, which has a higher infection rate than all other COVID-19 variants, has not even spared children, and many young children have been hospitalized with severe croup problems.

‘The current Omicron wave, which has a higher infection rate than all other COVID-19 variants, has not even spared children, and many young children have been hospitalized with severe croup problems.’

Croup is a common respiratory disease in infants and young children, caused by colds and other viral infections that cause swelling and inflammation around the larynx, trachea and bronchus. It has been characterized by a distinctive barking cough and sometimes high-pitched intakes of breath (known as a stridor). In severe cases, it can dangerously restrict breathing.

"The relatively high hospitalization rate and the large number of medication doses our COVID-19 croup patients required suggests that COVID-19 might cause more severe croup compared to other viruses," said study co-author Dr. Ryan Brewster, who is in the combined pediatrics residency program at Boston Children’s Hospital and Boston Medical Center.

Brewster also said, "Further research is needed to determine the best treatment options for these children,” in a Boston Children’s Hospital news release.

In this paper published, doctors described the cases of 75 children who went to Boston Children’s Hospital’s emergency department with croup and COVID-19 between March 1, 2020 and January 15, 2022.

Most of the children in the study were under 2 years of age, 72% of whom were boys. Except for one child with the common cold, no one is infected with the virus other than SARS-CoV-2.

Eighty percent of cases occurred after the coronavirus variant Omicron dominated in the United States.

Most of the children in the study were under age 2, and 72% were boys. Except for one child with a common cold virus, none had a viral infection other than SARS-CoV-2.

Just over 80% of the cases occurred after Omicron became the dominant coronavirus variant in the United States.

"There was a very clear delineation from when Omicron became the dominant variant to when we started seeing a rise in the number of croup patients," Brewster said.

No deaths were reported though, but nine (12%) were admitted to the hospital and four of those children required intensive care.

According to the study, before COVID-19, fewer than 5% of children with croup were hospitalized, and only 1% to 3% of hospitalized patients required intubation.

A total of 97% of children in the study and 29% of those treated in the emergency department were given the steroid dexamethasone. Everyone admitted to the hospital received racemic epinephrine via nebulizer, which is reserved for moderate or severe group cases.

Hospitalized children required a median of six doses of dexamethasone and eight nebulized epinephrine treatments to control their croup symptoms — more than is usually needed for non-COVID-19 croup and these findings were published in the journal Pediatrics.

The mild croup can be treated with steam from a humidifier at home or from hot showers, the study authors said, adding that parents should seek medical help if a child:

Has frequent noisy inhalations and barking cough at rest
Struggles to breathe
Has increased fatigue or sleepiness
Has blue lips or fingertips
Has a temperature higher than 100.4°F for more than three days
Has symptoms of mild croup lasting longer than seven days

Although many viruses can cause the croup, the authors suggested that parents should consider the possibility of their child having COVID-19 and think about testing them and other family members.

Limitations of this Study

The researchers conducted their analysis in a single center, with small sample size, which could control its generality. Nevertheless, this is one of the first and largest investigations into the COVID-19-related croup to date. An additional limitation is the absence of the virus genotyping.

The rapidness at which Omicron became the most dominant variant of SARS-CoV-2 reduces the concern about significant local circulation of other strains. Finally, the study does not rule out the possibility of co-infection with the virus due to the lack of comprehensive virus testing.

Source-Medindia