To describe the clinical-laboratory profile of pediatric Guillain-Barre syndrome and delineate features associated with need of mechanical ventilation.
Methods:
In a prospective observational study at tertiary care hospital, clinical-laboratory assessment and nerve conduction studies were documented in consecutive children hospitalized with Guillain-Barre syndrome according to Brighton criteria. Clinical-laboratory features were compared between ventilated and nonventilated patients using univariate and multivariate analysis.
Results:
Forty-six children (27 boys) with a mean age of 69.1±35.2 months were enrolled. History of preceding infection was present in 47.8%, bulbar palsy in 43.5%, feeble voice in 41.3%, sensory involvement in 13%, and autonomic involvement in 39.5%. Tetraparesis was noted in 87% of cases. Hughes disability scale >3 was noted in 44 children at admission and 39 (84.7%) at discharge. The most common electrophysiological type was acute motor axonal neuropathy (46.5%) followed by acute motor sensory axonal neuropathy (39.5%), acute inflammatory demyelinating polyneuropathy (7%), and inexcitable nerves (7%). Nine (19.7%) children were ventilated, 3 (6.5%) died or were lost, and 43 were discharged. Factors associated with need of mechanical ventilation on univariate analysis were older age, hypertension, bulbar palsy, feeble voice, lower Medical Research Council (MRC) sum, raised total leucocyte count, and history of preceding infection. Logistic regression revealed older age, history of predisposing illness, lower MRC sum at presentation, and bulbar palsy as independent predictors of mechanical ventilation.
Conclusions:
The most common electrophysiological subtype in northern Indian children is acute motor axonal neuropathy. Older age, preceding infection, low MRC sum, and bulbar palsy are predictors of mechanical ventilation in pediatric Guillain-Barre syndrome.
McGroganAMadleGCSeamanHEde VriesCS. The epidemiology of Guillain-Barré syndrome worldwide. A systematic literature review. Neuroepidemiology. 2009;32:150–163.
2.
RobertKYUsukiSArigaT. Ganglioside molecular mimicry and its pathological roles in Guillain-Barré syndrome and related diseases. Infect Immun. 2006;74:6517–6527.
NachamkinIAllosBMHoT. Campylobacter species and Guillain-Barré syndrome. Clin Microbiol Rev. 1998;11:555–567.
5.
YoshikawaH. Epidemiology of Guillain-Barré syndrome. Brain Nerve. 2015;67:1305–1311.
6.
GuillainGBarréJStrohlA. Sur un syndrome de radiculo-nevrite avec hyperalbuminose du liquide cephalorachidien sans reaction cellulaire. Remarques sur les characteres clinique et graphique des reflexes tendinaux [Radiculoneuritis syndrome with hyperalbuminosis of cerebrospinal fluid without cellular reaction. Notes on clinical features and graphs of tendon reflexes]. Bulletins et Memories de la Societe Medicale des Hopitaux de Paris. 1916;40:1462–1470.
7.
Van DoornPA. Treatment of Guillain-Barré syndrome and CIDP. J Peripher Nerv Syst. 2005;10:113–127.
8.
WijdicksEFKleinCJ. Guillain-Barré syndrome. Mayo Clin Proc. 2017;92:467–479.
9.
NettoABTalyABKulkarniGBUma Maheshwara RaoGSRaoS. Prognosis of patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurol India. 2011;59:707–711.
10.
IslamZPapriNAraG, et al.Risk factors for respiratory failure in Guillain-Barré syndrome in Bangladesh: a prospective study. Ann Clin Transl Neurol. 2019;6:324–332.
11.
NabiSKhattakSAwanMR. Clinical predictors of mechanical ventilation in Guillain-Barré syndrome. Pak J Neurol Sci. 2014;9:1–6.
12.
Kannan KanikannanMADurgaPVenigallaNKKandadaiRMJabeenSABorgohainR. Simple bedside predictors of mechanical ventilation in patients with Guillain-Barré syndrome. J Crit Care. 2014;29:219-223.
13.
PaulBSBhatiaRPrasadKPadmaMVTripathiMSinghMB. Clinical predictors of mechanical ventilation in Guillain-Barré syndrome. Neurol India. 2012;60:150–153.
14.
WalgaardCLingsmaHFRutsL, et al.Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol. 2010;67:781–787.
15.
LawnNDFletcherDDHendersonRDWolterTDWijdicksEF. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001;58:893–898.
16.
Van der PijlJWilmshurstJMvan DijkMArgentABoothJZampoliM. Acute flaccid paralysis in South African children: causes, respiratory complications and neurological outcome. J Paediatr Child Health. 2018;54:247-253.
17.
WuXShenDLiT, et al.Distinct clinical characteristics of pediatric Guillain-Barré syndrome: a comparative study between children and adults in Northeast China. PLoS One. 2016;11:e0151611.
18.
HuMHChenCMLinKL, et al.Risk factors of respiratory failure in children with Guillain-Barré syndrome. Pediatr Neonatol. 2012;53:295-299.
19.
RantalaHUhariMCherryJDShieldsWD. Risk factors of respiratory failure in children with Guillain-Barré syndrome. Pediatr Neurol. 1995;13:289–292.
20.
HundEFBorelCOCornblathDRHanleyDFMcKhannGM. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med. 1993;21:433–446.
21.
SejvarJJKohlKSGiduduJ, et al.Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2011;29:599–612.
22.
HughesRACNewsom-DavisJMPerkinGDPierceJM. Controlled trial of prednisolone in acute polyneuropathy. Lancet. 1978;312:750–753.
23.
HughesRCWijdicksEFMBarohnR, et al.Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2003;61:736–740.
24.
HaddenRDCornblathDRHughesRA, et al.Plasma exchange/sandoglobulin Guillain-Barré syndrome trial group. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol. 1998;44:780–788.
25.
AsburyAKCornblatDR. Assessment of current diagnostic criteria for Guillain-Barr syndrome. Ann Neurol. 1990;27:S21–S24.
26.
YadegariSNafissiSKazemiN. Comparison of electrophysiological findings in axonal and demyelinating Guillain-Barré syndrome. Iran J Neurol. 2014;13:138.
27.
KesiciSTanyıldızMYetimakmanFBayrakciB. A novel treatment strategy for severe Guillain-Barré syndrome: zipper method. J Child Neurol. 2019;34:277–283.
28.
OgawaraKKuwabaraSMoriMHattoriTKogaMYukiN. Axonal Guillain-Barré syndrome: relation to anti-ganglioside antibodies and Campylobacter jejuni infection in Japan. Ann Neurol. 2000;48:624–631.
29.
NachamkinIArzarte BarbosaPUngH, et al.Patterns of Guillain-Barré syndrome in children: results from a Mexican population. Neurology. 2009;72:1110.
30.
HoTWMishuBLiCY, et al.Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain J Neurol. 1995;118:597–605.
31.
SadekAAAbou-TalebAAliWA. Outcome of Guillain-Barré syndrome in children: a prospective cohort study in a tertiary hospital in Upper Egypt. Electron Physician. 2016;8:3318–3324.
32.
BarnesSLHerkesGK. Guillain-Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort. Intern Med J. 2020;50:1500–1504.
33.
H SiddiquiSH SiddiquiTU BabarMKhojaAKhanS. Outcomes of patients with Guillain Barre syndrome—experience from a tertiary care hospital of a developing Asian country and review of regional literature. J Clin Neurosci. 2019;62:195-198.
34.
SankhyanNSharmaSKonankiRGulatiS. Childhood Guillain-Barré syndrome subtypes in northern India. J Clin Neurosci. 2014;21:427–430.
35.
KumarMAroorSMundkurSKumarS. Guillain-Barré syndrome: a clinical study of twenty children. J Clin Diagn Res. 2015;9:SC09–SC12.
36.
KannanMAChRKJabeenSAMridulaKRRaoPBorgohainR. Clinical, electrophysiological subtypes and antiganglioside antibodies in childhood Guillain-Barré syndrome. Neurol India. 2011;59:727.
37.
KalitaJKumarMMisraUK. Prospective comparison of acute motor axonal neuropathy and acute inflammatory demyelinating polyradiculoneuropathy in 140 children with Guillain-Barré syndrome in India. Muscle Nerve. 2018;57:761–765.
38.
GuptaPKSinghiPSinghiSKasinathanASankhyanN. How different is AMAN from AIDP in childhood GBS? A prospective study from North India. Indian J Pediatr. 2019;86:329–334.
39.
YadavSJainPSharmaSKumarVAnejaS. Guillain-Barré syndrome in North Indian children: clinical and serial electrophysiological features. Neurol India. 2019;67:724–727.
40.
ShafqatSKhealaniBAAwanFAbedinSE. Guillain-Barré syndrome in Pakistan: similarity of demyelinating and axonal variants. Eur J Neurol. 2006;13:662–665.
41.
HungSKHiewFLRamlanRViswanathanSPuvanarajahS. Guillain-Barré syndrome, variants and forms fruste: reclassification with new criteria. J Neurol Sci. 2017;15:1075–1076.
42.
KalitaJKumarMMisraUK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré syndrome. J Clin Neurosci. 2020;72:50–56.
43.
KoulRAl-FutaisiAChackoA, et al.Clinical characteristics of childhood Guillain-Barré syndrome. Oman Med J. 2008;23:158–161.
44.
HaddenRDMKarchHHartungHP, et al.; The plasma exchange/sandoglobulin Guillain-Barré syndrome Trial Group. Preceding infections, immune factors and outcome in Guillain-Barré syndrome. Neurology. 2001;56:758–765.
45.
WalgaardCLingsmaHFRutsLvan DoornPASteyerbergEWJacobsBC. Early recognition of poor prognosis in Guillain-Barré syndrome. Neurology. 2011;76:968–975.
46.
NagappaMRahulWSinhaS, et al.Guillain Barre syndrome in the elderly: experience from a tertiary-care hospital in India. J Clin Neurosci. 2017;46:45-49.
47.
WuXLiCZhangB, et al.Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome. Crit Care. 2015;19:310.
48.
MaloniPKDespresERHabbousJ, et al.Perceptions of disability among mothers of children with disability in Bangladesh: implications for rehabilitation service delivery. Disabil Rehabil. 2010;32:845–854.
