A 10-day-old boy was addressed to our unit by his pediatrician for intermittent stridor associated with frequent episodes of desaturation while crying. Prenatal and perinatal periods were uneventful and the baby was born at term (41 weeks of gestation) to a primipara mother. Neonatal adaptation was good (Apgar score 8/9/10). The baby was small for gestational age with a weight of 2985 g (third to 10th percentile). A hoarse cry was present from the second day of life. He was exclusively breastfed without fatigue or perspiration during feeding. The weight gain was adequate (20 g per day). At 10 days of life, the physical examination demonstrated stridor with costal retraction and 86% oxygen saturation while crying (maximum 90 seconds), reason for which the child was hospitalized for further investigations.
OBJECTIVES:
Croup is the most common cause of acute upper airway obstruction in children. The benefits of treating croup with steroids are well established, with an onset of effect 30 minutes after administration. We investigated whether a 30-minute exposure to outdoor cold air might improve mild to moderate croup symptoms before the onset of action of steroids.
METHODS:
This open-label, single-center, randomized controlled trial, enrolled children aged 3 months to 10 years with croup and a Westley Croup Score (WCS) ≥2 attending a tertiary pediatric emergency department. Participants were randomized (1:1) to either a 30-minute exposure to outdoor cold (<10°C) atmospheric air or to indoor ambient room air immediately after triage and administration of a single-dose oral dexamethasone. The primary endpoint was a decrease in WCS ≥2 points from baseline at 30 minutes. Analyses were intention to treat.
RESULTS:
A total of 118 participants were randomly assigned to be exposed to outdoor cold air (n = 59) or indoor room temperature (n = 59). Twenty-nine of 59 children (49.2%) in the outdoor group and 14 of 59 (23.7%) in the indoor group showed a decrease in WCS ≥2 points from baseline at 30 minutes after triage (risk difference 25.4% [95% confidence interval 7.0–43.9], P = .007). Patients with moderate croup benefited the most from the intervention at 30 minutes (risk difference 46.1% [20.6–71.5], P < .001).
CONCLUSIONS:
A 30-minute exposure to outdoor cold air (<10°C), as an adjunct to oral dexamethasone, is beneficial for reducing the intensity of clinical symptoms in children with croup, especially when moderate.
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