Ulcerative laryngitis in children admitted to intensive care

Background

Severe ulcerative laryngitis is rarely documented in children.

Objective

To present our experience of ulcerative laryngitis over a 5 year period.

Setting

Paediatric Intensive Care Unit (PICU) of a university hospital.

Methods

Retrospective case note review of 263 children admitted to PICU with severe upper airway obstruction and a clinical diagnosis of croup. Data are presented as median (range) and analysed by the Fisher's Exact test.

Results

One hundred and forty-eight children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope), usually at the time of airway intervention for failed medical treatment of severe croup (n = 147). Laryngeal ulceration, with or without exudation, oedema and erythema, was documented in 15 of these children (10%), median age 14 months (10–36) and median weight 10 kg (6–12). Twenty-seven of the children who underwent microlaryngoscopy (18%) also had ulcerative gingivostomatitis consistent with Herpes simplex virus. Ulcerative laryngitis was documented in 9 of 27 (33%) children with, and in 6 of 121 (5%) children without, co-existent ulcerative gingivostomatitis (P < 0.002). The presence of oral ulcers predicted ulcerative laryngitis with sensitivity and specificity of 80% and 86%, and positive and negative predictive values of 33% and 95%. Viral culture was available in 6 of the 15 children with ulcerative laryngitis, confirming Herpes simplex (n = 3) and cytomegalovirus (n = 1). All children with oral or laryngeal ulceration received acyclovir therapy.

One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median of 4 days (3-11) and median ICU stay of 6 days (4–14). Five children required tracheostomy ab initio, with a median ICU stay of 30 days (20–36), and duration of tracheostomy in situ for a median of 19 days (15–253). All 15 children survived.

Conclusion

Ulcerative laryngitis is more common in our patient population than the few reports suggest. Early microlaryngoscopy is recommended in children with severe croup who follow an atypical course.