The omicron coronavirus variant has caused an increase in cases of potentially serious respiratory disorders in babies and toddlers, hospital study finds recently published in the journal Pediatrics.
The study is small, focusing only on cases associated with COVID-19 at a large children’s hospital in Massachusetts during the pandemic. But, it provides some of the initial data on the subject and corroborates anecdotal stories from health care providers that the latest pandemic variant is causing more cases of laryngotracheobronchitis – aka croup— in younger children than earlier variants.
Generally, croup is a common upper respiratory condition in which significant inflammation and swelling develops in the larynx and trachea, compromising breathing. Some viral infections usually trigger swelling, but allergies and other irritants can also be responsible. Croup can occur at any age, but primarily strikes the tiny upper airways of infants and young children, ages 3 months to 5 years old.
Croup gets its name from the characteristic “croup” cough it causes, which is sometimes described as a barking, seal-like cough. Other hallmarks of the condition are a harsh, grating sound when a patient breathes – inspiratory stridor – and respiratory distress.
Prior to the omicron wave, COVID-19 was associated with croup in some children, but this did not appear to be a common result of pandemic infection. This changed during the omicron wave when healthcare providers reported that they had seen more cases of croup associated with COVID-19 in younger patients.
Although data remains sparse on why this might be the case, experts speculate that early variants and ancestral SARS-CoV-2 tended to target the lower respiratory tract, resulting in more severe disease in groups of older age. Meanwhile, Omicron appears to have a predilection for the upper respiratory tract, which may partly explain why it is both more transmissible and associated with relatively milder disease in older age groups.
But, in very young children – who have tiny airways and are still not eligible for the COVID-19 vaccination – omicron appears to pose a new risk.
Case of croup
In the new study, researchers, led by pediatrician Ryan Brewster of Boston Children’s Hospital, scanned hospital records for cases of croup associated with COVID-19 from March 2020 through January 15, 2022. They found no only 75 cases, but 61 of the cases (81 percent) occurred during the approximately one and a half month period of the omicron wave, from December 4, 2021 to January 15, 2022.
Prior to omicron, only 14 cases of croup associated with COVID-19 emerged from March 2020 through early December 2021, typically with no more than one case per week. Of these cases, 12 went to the emergency room and two were hospitalized. But at the height of Massachusetts’ omicron surge in early 2022, croup associated with COVID-19 peaked at about two dozen cases in a week. Of the 61 cases of omicron period croup, 54 went to the emergency room and seven were hospitalized.
No other spike in COVID-19 has been linked to a spike in croup cases. And in cases where doctors have tested children for possible co-infections, all of the children have tested negative except for one who tested positive for rhinovirus (a common cold).
The researchers also noted that cases of croup associated with COVID-19, widely seen during the omicron period, appeared to skew towards more severe croup than is seen in cases caused by other viral infections. Croup associated with COVID-19 caused more hospitalizations and required more new dosages of treatments than expected, the researchers report. Four cases required intensive care, but none resulted in invasive ventilation or death.
For cases not associated with COVID-19, croup is often considered mild and can sometimes be managed at home with simple treatments and over-the-counter medications, such as acetaminophen (Tylenol). Most importantly, experts recommend bringing a baby or toddler with croup into damp or cold air – a humid bathroom or outside on a winter night (croup is often worse the night). Cold and humidity help relieve inflammation and loosen mucus. But, in cases where a young child is having trouble breathing, a visit to the emergency room can provide quick relief with a steroid, such as the glucocorticoid dexamethasone, to reduce inflammation.
Although the Massachusetts study is limited by its small size and unique location, the authors argue that it offers compelling preliminary evidence that omicron infections cause croup, sometimes severe croup, and the study warrants further investigation. additional.
“Two years into the COVID-19 pandemic, the pathogenicity, infectivity, and manifestations of novel SARS-CoV-2 variants have been dynamic and unique,” they write. “The group may represent yet another of these new presentations.”
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