Italian Pediatric Respiratory Society (SIMRI) position paper on treatment of croup in childhood: an expert group statement approved by SIMRI Advocacy Council and Executive Committee

Croup, also known as acute laryngotracheobronchitis, is common in the first years of life and is mainly caused by respiratory viral infections leading to laryngeal edema with subsequent onset of hoarseness, barking cough and stridor.Although most of the cases are classified as mild, some patients may show severe respiratory distress requiring up to intensive care.Moreover, even mild and moderate cases result in a high rate of pediatric emergency departments visits since croup symptoms, often occurring at night, can be frightening for caregivers.Treatment of pediatric croup is based on corticosteroids administration, with the addition of inhaled epinephrine in severe cases.However, croup management is still highly heterogeneous worldwide due to the paucity of dedicated randomized controlled trials.This statement outlines the most recent evidence supporting the use of corticosteroids and epinephrine in the treatment of croup in childhood and reports the recommendations for optimal treatment from the Italian Pediatric Respiratory Society (Societ Italiana per le Malattie Respiratorie Infantili -SIMRI).Impact statement: systemic corticosteroids represent the first-line treatment for managing croup in childhood, with the addition of inhaled epinephrine in severe cases.However, management of this condition is heterogeneous worldwide due to the lack of evidence-based guidelines and paucity of dedicated randomized clinical trial.This statement outlines the evidence supporting the use of corticosteroids and epinephrine in the treatment of croup in childhood and reports the recommendations of the Italian Pediatric Respiratory Society (Societ Italiana per le Malattie Respiratorie Infantili -SIMRI) in treating this condition.The statement will have a significant role in improving croup treatment at least at a national level.