A Cochrane review[Abstract] 1 included 8 studies with a total of 225 children. Severity of croup in the majority of enrolled children was judged to be moderate or moderate to severe. Three comparisons were examined: nebulized adrenaline (NA) versus placebo (6 studies; 5 studies used racemic adrenaline and 1 used L-adrenaline), nebulized racemic adrenaline versus L-adrenaline (1 study) and NA with intermittent positive pressure breathing (IPPB) versus NA without IPPB (1 study). NA was associated with croup score improvement 30 minutes post-treatment (SMD -0.94, 95% CI -1.37 to -0.51; 3 studies with racemic adrenaline, n=94). This effect was not significant 2 (SMD -0.15, 95% CI -1.03 to 0.73; 1 study, n=20) and 6 (SMD -0.60, 95% CI -1.12 to -0.08; 2 studies, n=138) hours post-treatment. NA was associated with significantly shorter hospital stay than placebo (MD -32.0 hours, 95% CI -59.1 to -4.9; 1 study, n=37). Comparing racemic and L-adrenaline, no difference in croup score was found after 30 minutes (SMD 0.33, 95% CI -0.42 to 1.08; 1 study, n=28). After two hours, L-adrenaline showed significant reduction compared with racemic adrenaline (SMD 0.87, 95% CI 0.09 to 1.65; 1 study, n=28); indicating L-adrenaline to have a longer duration of benefit than racemic adrenaline. There was no significant difference in croup score between administration of NA via IPPB versus nebulization alone at 30 minutes (SMD -0.14, 95% CI -1.24 to 0.95; 1 study, n=14) or two hours (SMD -0.72, 95% CI -1.86 to 0.42).
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