COVID Croup: Pediatric Croup Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2; Covid-19).

ImportanceDuring the COVID-19 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] pandemic, reports emerged of croup secondary to SARS-CoV-2 in the pediatric population. Children with croup and concurrent SARS-CoV-2 infection seemed to require a greater number of doses of dexamethasone and nebulized epinephrine and were more likely to need hospitalization and intensive care unit (ICU) admission compared to pre-SARS-CoV-2 croup.ObjectiveThis study aimed to compare the outcomes of children presenting with SARS-CoV-2-associated croup and those with conventional croup.DesignObservational, retrospective review.SettingTertiary care pediatric hospital.ParticipantsChildren (age <18 years) presenting with croup between January 2019 and February 2022.ExposureSARS-CoV-2Main outcome measureNumber of doses of dexamethasone and nebulized epinephrine, need for hospital admission, ICU admission, assisted ventilation, and length of stay.ResultsTwo thousand and three hundred ninety-eight children [68.2% male, median (interquartile range) age 25 months (15-42 months)] were included. Twenty-seven patients (1.1%) tested positive for SARS-CoV-2, 467 (19.5%) tested negative for SARS-CoV-2, and 1904 (79.4%) were not tested for SARS-CoV-2. Dexamethasone was given to 27 (100%) SARS-CoV-2-positive and 457 (98%) SARS-CoV-2-negative patients at an average of 1.4 (±1.2) and 1.1 (±1.0) doses, respectively. SARS-CoV-2-positive patients were more likely to require nebulized epinephrine (41%) compared to SARS-CoV-2-negative (12%, OR: 4.2; 95% CI 1.8-9.6, P < .001) patients, and were more often admitted (30%) to hospital than SARS-CoV-2-negative (3.4%) patients (OR: 12; 95% CI 4.4-37.7, P < .001). ICU admission was required for 3 SARS-CoV-2-negative patients, but none of the SARS-CoV-2-positive patients. Length of stay was similar across groups.ConclusionPatients with croup and SARS-CoV-2 infection were found to have an increased need for nebulized epinephrine and an increased frequency of admission to the hospital. However, there was no increased need for ICU admission or longer length of stay in the hospital.Level of EvidenceIII.