Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice
This mini-review critically evaluates the contemporary evidence regarding racemic epinephrine's role in pediatric croup management. As the pharmacological mainstay for acute airway obstruction, racemic epinephrine demonstrates rapid efficacy through dual α₁-adrenergic vasoconstriction and β2-me...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1616521/full |
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| author | Yu-tong Hou Qi Shi Lin Zhang Qian Cheng |
| author_facet | Yu-tong Hou Qi Shi Lin Zhang Qian Cheng |
| author_sort | Yu-tong Hou |
| collection | DOAJ |
| description | This mini-review critically evaluates the contemporary evidence regarding racemic epinephrine's role in pediatric croup management. As the pharmacological mainstay for acute airway obstruction, racemic epinephrine demonstrates rapid efficacy through dual α₁-adrenergic vasoconstriction and β2-mediated bronchodilation, achieving clinically significant Westley Croup Score reductions (2–3 points) within 30 min of administration. Current evidence establishes therapeutic equipoise between racemic and L-epinephrine formulations, though important disparities exist in global accessibility and cost-effectiveness. The transient therapeutic window (90–120 min) necessitates careful monitoring and underscores the importance of concomitant corticosteroid administration for sustained symptom control. While the safety profile remains favorable, with transient cardiovascular effects representing the primary concern, several evidence gaps persist regarding optimal retreatment intervals, viral subtype-specific responses, and long-term neurodevelopmental outcomes. Emerging research directions highlight the potential of advanced delivery systems and biomarker-guided approaches to optimize therapy. These findings collectively reinforce racemic epinephrine's position as an essential bridging intervention during the critical latency period preceding corticosteroid efficacy, while emphasizing the need for standardized protocols to ensure optimal clinical implementation across diverse healthcare settings. |
| format | Article |
| id | doaj-art-bce37da7b68041bb885e2ae22847896f |
| institution | OA Journals |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-bce37da7b68041bb885e2ae22847896f2025-08-20T02:36:53ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-06-011310.3389/fped.2025.16165211616521Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practiceYu-tong Hou0Qi Shi1Lin Zhang2Qian Cheng3Department of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, ChinaDepartment of Pediatric Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, ChinaDepartment of Pediatric Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, ChinaDepartment of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, ChinaThis mini-review critically evaluates the contemporary evidence regarding racemic epinephrine's role in pediatric croup management. As the pharmacological mainstay for acute airway obstruction, racemic epinephrine demonstrates rapid efficacy through dual α₁-adrenergic vasoconstriction and β2-mediated bronchodilation, achieving clinically significant Westley Croup Score reductions (2–3 points) within 30 min of administration. Current evidence establishes therapeutic equipoise between racemic and L-epinephrine formulations, though important disparities exist in global accessibility and cost-effectiveness. The transient therapeutic window (90–120 min) necessitates careful monitoring and underscores the importance of concomitant corticosteroid administration for sustained symptom control. While the safety profile remains favorable, with transient cardiovascular effects representing the primary concern, several evidence gaps persist regarding optimal retreatment intervals, viral subtype-specific responses, and long-term neurodevelopmental outcomes. Emerging research directions highlight the potential of advanced delivery systems and biomarker-guided approaches to optimize therapy. These findings collectively reinforce racemic epinephrine's position as an essential bridging intervention during the critical latency period preceding corticosteroid efficacy, while emphasizing the need for standardized protocols to ensure optimal clinical implementation across diverse healthcare settings.https://www.frontiersin.org/articles/10.3389/fped.2025.1616521/fulllaryngotracheobronchitiscroupracemic epinephrinepediatricreview |
| spellingShingle | Yu-tong Hou Qi Shi Lin Zhang Qian Cheng Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice Frontiers in Pediatrics laryngotracheobronchitis croup racemic epinephrine pediatric review |
| title | Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice |
| title_full | Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice |
| title_fullStr | Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice |
| title_full_unstemmed | Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice |
| title_short | Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice |
| title_sort | clinical advances in racemic epinephrine for pediatric croup a mini review of evidence and practice |
| topic | laryngotracheobronchitis croup racemic epinephrine pediatric review |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1616521/full |
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