One RCT reported one child with pneumonitis in the placebo group (1/13, 7.7%) and two children with pneumonia in the dexamethasone group (2/16, 12.5%). One RCT reported one child with neutropenia in the dexamethasone group (1/28, 3.57%) and another one, seven secondary bacterial infections (pneumonia, sinusitis, otitis media) requiring antibiotic therapy: 5/35, 14% in the dexamethasone group and 2/16, 12.5% in the placebo group. One RCT reported seven cases of pneumonia (3/359, 0.83% in the dexamethasone group and 4/361, 1.11% in the placebo group). Thirteen RCTs with 1399 participants reported adverse events. Glucocorticoid versus epinephrine was assessed in too few children (32 to 130) to permit any conclusions. Adverse events were sparsely reported and were assessed in too few children to provide a reliable assessment the lack of an adverse event profile to supplement the efficacy data precludes any firm conclusions. The impact of glucocorticoid on the need for additional treatments such as antibiotics, epinephrine, intubation/tracheostomy, and supplemental glucocorticoids remains unclear.

In addition, duration of hospital stay was shorter (by 15 hours), and fewer children returned to the ED or were readmitted to hospital (79 vs 1 children) when administered a glucocorticoid.

The number of children with improved symptoms was also greater at 6 to 24 hours with a glucocorticoid (184 to 206 more children improved per 1000 children all results on average). For children (where reported, mean age one to three years) presenting to the emergency department (ED) or hospitalized with croup, the use of a glucocorticoid substantially improved croup scores at two (moderate‐certainty evidence) to 24 (low‐certainty evidence) hours when compared with placebo.

Epinephrine disorders