Recurrent episodes of viral croup in children: potential causes and approaches to its prevention
DOI:
https://doi.org/10.15574/SP.2021.115.15Keywords:
recurrent episodes, viral croup, children, causes, preventionAbstract
Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup.
Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention.
Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years.
Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (>6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D>30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D>30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29).
Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to >30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the author.
References
Abaeva NG, Vernigora ND, Safronenko LA, Karpov VV, Lukashevich MG, Disenbaeva LG, Golovina EM. (2018). Recidiviruyushchij obstruktivnyj laringit u detej: problemy i puti resheniya. Klinicheskaya praktika. 9 (3): 4-9. https://doi.org/10.17816/clinpract0934-9
Bower J, McBride JT. (2015). Croup in Children (Acute Laryngotracheobronchitis). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 2015: 762-6.e1. https://doi.org/10.1016/B978-1-4557-4801-3.00061-8; PMCid:PMC7173542
Car'kova SA. (2016). Ostryj stenoziruyushchij laringotraheit u detej. Rossijskij vestnik perinatologii i pediatrii. 61 (1): 96-103. https://doi.org/10.21508/1027-4065-2016-61-1-96-103
Coughran A, Balakrishnan KMaY, Vaezeafshar R, Capdarest-Arest N, Hamdi O, Sidell DR. (2021). The Relationship between Croup and Gastroesophageal Reflux: A Systematic Review and Meta-Analysis. Laryngoscope. 131 (1): 209-217. https://doi.org/10.1002/lary.28544; PMid:32040207
Defendi GL. (2019). Croup. Medscape. URL: http://emedicine.med-scape.com/article/962972-overview.
Duval M, Tarasidis G, Grimmer JF, Muntz HR, Park AH, Smith M, Meier J. (2015). Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study. Clinical Otolaryngology. 40 (3): 227-233. https://doi.org/10.1111/coa.12353; PMid:25409938
Feleszko W, Marengo R, Vieira AS, Ratajczak K, Mayorga Butron JL. (2019). Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children. Clinical Otolaryngology. 44 (4): 502-510. https://doi.org/10.1111/coa.13335; PMid:30920131 PMCid:PMC6850198
Gruber-Bzura BM. (2018). Vitamin D and influenza-prevention or therapy? International journal of molecular sciences. 19 (8): 2419. https://doi.org/10.3390/ijms19082419; PMid:30115864 PMCid:PMC6121423
Hanna R, Lee F, Drummond D, Yunker WK. (2019). Defining atypical croup: A case report and review of the literature. International journal of pediatric otorhinolaryngology. 127: 109686. https://doi.org/10.1016/j.ijporl.2019.109686; PMid:31542653 PMCid:PMC7112844
Herasimchuk TS. (2016). Udoskonalennia profilaktyky respiratornykh infektsii u ditei rannoho viku ta prohnozuvannia yikh rekurentnoho perebihu. Dysertatsiia. Zaporizkyi derzhavnyi medychnyi universytet, Zaporizhzhia.
Hiebert JC, Zhao YD, Willis EB. (2016). Bronchoscopy findings in recurrent croup: A systematic review and meta-analysis. International journal of pediatric otorhinolaryngology. 90: 86-90. https://doi.org/10.1016/j.ijporl.2016.09.003; PMid:27729160
Holick MF, Binkley NC, Bishoff-Ferrari HA. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guidline. The Journal of Clinical Endocrinology & Metabolism. 96 (7): 1911-1930. https://doi.org/10.1210/jc.2011-0385; PMid:21646368
Jeon IS, Cho WJ, Lee J, Kim HM. (2018). Epidemiology and clinical severity of the hospitalized children with viral croup.Pediatric Infection and Vaccine. 25 (1): 8-16. https://doi.org/10.14776/piv.2018.25.1.8
Johnson DW. (2016). Croup. American family physician. 94 (6): 476-478.
Jolliffe DA, Camargo JrCA, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, Martineau AR. (2021). Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. The Lancet Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(21)00051-6.
Lin SC, Lin HW, Chiang BL. (2017). Association of croup with asthma in children: A cohort study. Medicine. 96 (35): e7667. https://doi.org/10.1097/MD.0000000000007667; PMid:28858086 PMCid:PMC5585480
Maidannyk VH. (2015). Hostryi obstruktyvnyi larynhit (krup) u ditei: ohliad suchasnykh klinichnykh rekomendatsii. Zdorov'ia Ukrainy. 4 (35): 22-23.
Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, Griffiths CJ. (2016). Vitamin D for the management of asthma. Cochrane Database of Systematic Reviews. 5,9 (9): CD011511.
Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Goodall EC. (2017). Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 356: i6583. https://doi.org/10.1136/bmj.i6583; PMid:28202713 PMCid:PMC5310969
Medrano M, Carrillo-Cruz E, Montero I, Perez-Simon JA. (2018). Vitamin D: effect on haematopoiesis and immune system and clinical applications. International journal of molecular sciences. 19 (9): 2663. https://doi.org/10.3390/ijms19092663; PMid:30205552 PMCid:PMC6164750
Ministerstvo okhorony zdorovia Ukrainy. (2004). Pro zatverdzhennia klinichnykh Protokoliv nadannia medychnoi dopomohy pry nevidkladnykh stanakh u ditei na shpytalnomu ta do shpytalnomu etapakh. Nakaz MOZ Ukrainy No. 437. URL: https://zakon.rada.gov.ua/rada/show/v0437282-04/.
Mozzhuhina LI, CHelnokova OG, Kogut TA, Salova AL. (2019). Sindrom krupa i pervichnoe inficirovanie mikobakteriyami tuberkuleza u detej. Medicinskij sovet. 2: 216-219. https://doi.org/10.21518/2079-701X-2019-2-216-219
Pruikkonen H, Dunder T, Renko M, Pokka T, Uhari M. (2009). Risk factors for croup in children with recurrent respiratory infections: a case-control study. Paediatric and perinatal epidemiology. 23 (2): 153-159. https://doi.org/10.1111/j.1365-3016.2008.00986.x; PMid:19159401
Safronenko LA, Davydova AP, Karpov VV, Lukashevich MG, Novikov VA. (2017). Problemy lecheniya stenoziruyushchego laringotraheita u detej (rezul'taty 35-letnego opyta). Vestnik otorinolaringologii. 82 (3): 19-21. https://doi.org/10.17116/otorino201782319-21; PMid:28631673
Samieva GU, Abdirashidova GA, Sobirova SHB. (2017). Prognosticheskoe znachenie spektra citokinov i ih izmeneniya pri pervichnyh i recidiviruyushchih laringotraheitah u detej. Mezhdunarodnaya nauchnoprakticheskaya konferenciya. Innovacionnye issledovaniya: problemy vnedreniya rezul'tatov i napravleniya razvitiya. Ufa: Omega Sajns.
Sassi F, Tamone C, D'Amelio P. (2018). Vitamin D: nutrient, hormone, and immunomodulator. Nutrients. 10 (11): 1656. https://doi.org/10.3390/nu10111656; PMid:30400332 PMCid:PMC6266123
Savilahti EM, Makitie O, Kukkonen AK, Andersson S, Viljakainen H, Savilahti E, Kuitunen M. (2016). Serum 25-hydroxyvitamin D in early childhood is nonlinearly associated with allergy. International archives of allergy and immunology. 170 (3): 141-148. https://doi.org/10.1159/000447636; PMid:27533066
Sharma BS, Shekhawat DS, Sharma P, Meena C, Mohan H. (2015). Acute respiratory distress in children: croup and acute asthma. The Indian Journal of Pediatrics. 82 (7): 629-636. https://doi.org/10.1007/s12098-014-1559-4; PMid:25257964
Smith DK, McDermott AJ, Sullivan JF. (2018). Croup: diagnosis and management. American family physician. 97 (9): 575-580.
Teymoori-Rad M, Shokri F, Salimi V, Marashi SM. (2019). The interplay between vitamin D and viral infections. Reviews in medical virology. 29 (2): e2032. https://doi.org/10.1002/rmv.2032; PMid:30614127
Tiazhka OV, Selska ZV. (2015). Zabezpechenist vitaminom D ditei z riznymy formamy alerhichnykh zakhvoriuvan. Sovremennaia pedyatryia. 7: 89-91.
Uchajkin VF. (2001). Rukovodstvo po infekcionnym boleznyam u detej. Moskva: GEOTAR media: 824.
Westley CR, Cotton EK, Brooks JG. (1979). Nebulized Racemic Epinephrine by IPPB for the treatment of Croup. A double-blind study. Survey of Anesthesiology. 23 (4): 254. https://doi.org/10.1097/00132586-197908000-00043
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Modern Pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
