الفهرس 
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Abstract
Background: Croup is one of the most common causes for children to present to the Emergency Department (ED). Systemic corticosteroids are the main stay treatment in croup and its clinical benefit is well established. Numerous studies have demonstrated that all corticosteroid routes are more effective than placebo when used alone for croup; however, till now no strong evidence that combining systemic dexamethasone (0.6mg/kg) and nebulized budesonide (2mg) provides a clear advantage over using either drug alone. The aim of the work: This research will study the value of adding nebulized budesonide to the standard treatment of viral croup in children with moderate and severe croup. Enrolled children will be evaluated for the need to be admitted or not, Improvement in croup score compared to the pre-treatment score and the duration needed for treatment in emergency room for children who did not need admission. Also children will be evaluated for the need to re-attend to the emergency room for further treatment. Type of study: randomized controlled single blind trial Materials and Methods This randomized controlled single blind trial study included 80 Infant and children who attended the emergency room of Mansoura University Children’s Hospital, from July 2017 to November 2018, with moderate to severe viral croup as defined by Westley croup score. They were randomized into two groups: Standard treatment (include 40 children) and Budesonide group (include 40 children). The study was conducted in the period from July 2017 to November 2018.Signed informed consents were obtained from the parents of all children to be enrolled in the study. Results: In our study, Number of nebulized adrenaline doses was statistically significant higher in standard treatment group, significant reduction in the croup score in budesonide group, emergency room stay duration was statistically significant lower in budesonide group, return visits within 7-10 days was statistically significant lower in budesonide group. Conclusion: from the data obtained from the current study it can be concluded that adding nebulized budesonide to the standard treatment in children with moderate to severe croup was associated with improving croup as regard croup score, emergency room stay duration and return visits within 7-10 days and had no considerable short term adverse effect. • Recommendations: • Based on results of our study we can recommend adding inhaled budesonide to standard treatment of moderate to severe croup. • Performing further study to show the value of inhaled budesonide alone without systemic corticosteroid in mild to moderate viral croup as an easier alternative. • Further larger study may be needed before the recommendations can be safely incorporated into management protocols. - It is also worth considering to perform cost modelling analysis to show cost-benefit value of routine use of nebulized budesonide in children with moderate to severe viral croup.