Although young children with Covid-19 generally experience mild illness, the omicron coronavirus variant has led to more children being hospitalized with Covid-19 in recent months at a rate five times higher than with the Delta variant.
Now a new paper from researchers at Boston Children’s Hospital has described 75 cases of croup in children with Covid-19, a previously uncommonly reported manifestation of Covid-19 in this age group. Croup is a common illness in babies and young children characterized by a bark-like cough and sometimes noisy, high pitched breathing. It can be caused by a number of different respiratory viruses and causes swelling around the voice box and windpipe and bronchial tubes leading to the lungs.
Croup is generally mild in children with fewer than 5% of children requiring hospitalization prior to the pandemic. But worryingly, in the 75 patients with croup caused by Covid-19 infection in the new study, 12% of the children needed hospital care, with just under half of these needing intensive care. All of the affected children in the paper were under 5 and therefore not yet eligible for Covid-19 vaccination.
Although the information about the croup cases was collected between March 2020 and January 2022, 80% of the cases in the study occurred during a period of time where omicron was the dominant coronavirus variant and the study authors suggest that omicron may be more likely to cause croup than previous variants.
“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,” said Ryan Brewster, MD, first author of the report and a first-year resident in the Boston Combined Residency Program in Pediatrics at Boston Children’s Hospital and Boston Medical Center.
There is some evidence to suggest that the omicron variant is more likely to infect the upper airway than other coronavirus variants and the researchers suggest that this might be a reason as to why they are seeing more cases of croup caused by the omicron variant. Almost all of the children with Covid-19 and croup were treated with dexamethasone, an old steroid medication which is commonly prescribed for people with Covid-19 who are sick enough to require treatment. The children who were hospitalized also received epinephrine via a nebulizer and thankfully, all of the children in the study survived.
“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 Brewster indicating that further research is required to determine the best treatment options for children with croup caused by SARS-CoV2.
The authors urge parents to be aware that although croup can be caused by many different viruses, parents should consider testing for Covid-19 if their child develops croup.
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