The omicron strain increases the risk of developing croup in children - inflammation of the airways, sometimes leading to their obstruction, American scientists say. Children with severe croup or tracheitis are at risk of cardiac arrest due to rapidly onset upper airway obstruction, they warn. Russian doctors have confirmed that the development of croup in children is possible, told why this happens and how dangerous it can be. The number of cases of croup in children with COVID-19 has increased significantly against the backdrop of the spread of the omicron strain, experts at the University of Colorado School of Medicine at Aurora found out. Because omicron affects the upper respiratory tract, it can lead to this complication, according to an as-yet-peer-reviewed article, the preprint of which was posted on the medRxiv website.
“Croup syndrome is when a person, against the background of a respiratory viral infection, develops inflammation of the mucous membranes, swelling of the mucous membrane of the larynx, that is, the airways are narrowed,” explained pediatrician and immunologist Andrey Prodeus. - In 99% of cases, this occurs against the background of a respiratory infection. "Omicron" is in fact a respiratory infection - an infection of the upper respiratory tract.
Accordingly, with him, if we take a conditionally healthy person, of course, croup will develop, there is nothing surprising in this, nothing terrible and nightmarish.
Children with upper airway hyperreactivity are predisposed to developing croup, says Prodeus. Some viral infections involve the lining of the upper respiratory tract more, which increases the risk. Such infections include, among other things, coronaviruses, rhinoviruses, adenoviruses, influenza viruses.
The authors of the work collected data on almost 16 thousand children and adolescents under the age of 19 hospitalized with COVID-19. Of these, 234 developed croup or tracheitis—the latter was included in the sample due to the similarity of its symptoms to croup, and bacterial tracheitis may be a complication of viral croup.
As it turned out, most cases of croup - 170 - occurred in December, when the "omicron" spread.
Most often, croup and tracheitis affected children aged 1.3 to 5.6 years. At risk were boys, white, often with asthma and severe COVID-19.
“Coronavirus infection really actively multiplies in the upper respiratory tract, in adults very often causing a lesion that manifests itself in the form of sore throats, in the form of severe hoarseness,” said pediatrician and infectious disease specialist Yevgeny Timakov.
- In young children, ligaments are also affected. In children, the structure of the ligaments and submucosa is such that it is more prone to swelling. They develop a state of croup, as in other viral infections, such as parainfluenza.
Plus, children under the age of five often have, in addition to croup, symptoms of bronchiolitis, when small bronchioles are affected.
“Children with severe croup or tracheitis are at risk of cardiac arrest due to rapidly onset upper airway obstruction,” the authors warn. "They may require therapies usually given in intensive care units, including frequent inhalations of epinephrine, helium-oxygen mixtures, and intubation."
However, there is no serious reason to panic, Prodeus notes.
The article notes that no more than 1.5% of children developed croup, the scientist added. Moreover, most of them, the vast majority, had either asthma or some concomitant diseases.
Omicron infects not so much the lungs as the upper respiratory tract, and this is just a positive factor, explains Prodeus. - All previous strains were dangerous precisely by the defeat of the lower respiratory tract. And there were respiratory disorders, and other manifestations, more serious.
The researchers' findings could be important for doctors and parents, Timakov adds. Knowing about the possible risks, it is possible to carry out prevention by using anti-inflammatory drugs or inhalation with hormonal agents.
“This should be considered as one of the symptoms of a coronavirus infection, which is specific to Omicron, because other variants of SARS-CoV-2 did not cause such manifestations,” he says. - And when we see hoarseness of voice in children, we need to understand that this can then cause a croupy state, pain in the throat. Therefore, you can think about prevention in advance.”
In general, the incidence of COVID-19 among children is not too high, the authors write. But unforeseen complications can add to the burden on the healthcare system. Therefore, doctors should take into account possible risks and use this information when planning therapy.
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