Abstract
ObjectiveClinical characteristics of pediatric Guillain-Barré syndrome (GBS) have been extensively studied whereas scarcely been compared with those of adult GBS. Herein we compared the clinical features of GBS between pediatric and adult patients.MethodsWe retrospectively collected the clinical data of 750 patients with GBS (541 adults and 209 children), and compared the clinical characteristics between children and adults.ResultsPain was a more frequent complaint in children (17.2% vs 9.6%, p < 0.01), who were also found with shorter interval from disease onset to nadir (6.3d vs 7.3d, p < 0.01) and higher incidence of bulbar dysfunction (22.0% vs 14.8%, p < 0.05). The disease severity in children was comparable with adults. In addition, a higher incidence of pediatric GBS was found in summer, especially in July and August (both p < 0.01). However, the incidence of antecedent infections of different seasons in adult and pediatric patients was comparable (p > 0.05). The clinical features of acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) in children were overall comparable with adult ones (p > 0.05). Similar to adults, bulbar dysfunction (odds ratio [OR]: 4.621, 95% confidence interval [CI]: 1.240–17.218, p < 0.05) and lower nadir Medical Research Council (MRC) sum score (OR: 0.897, 95% CI: 0.855–0.941, p < 0.01) were also risk factors for mechanical ventilation in children. However, distinct from adult ones, autonomic dysfunction was significantly higher in mechanically ventilated childhood GBS (39.1% vs 8.8%, p < 0.01), which also served as a predictor for mechanical ventilation in pediatric GBS (OR: 70.415, 95% CI: 9.265–535.158, p < 0.01). As to the efficacy of intravenous immunoglobulin, insignificant difference was identified between children and adults.ConclusionThe clinical features of pediatric GBS differ from those of adults. Autonomic dysfunction is an independent risk factor for mechanical ventilation in pediatric patients.
Highlights
Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system which is triggered by either infectious or noninfectious factors [1]
The clinical features of acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) in children were overall comparable with adult ones (p > 0.05)
Bulbar dysfunction and lower nadir Medical Research Council (MRC) sum score (OR: 0.897, 95% CI: 0.855–0.941, p < 0.01) were risk factors for mechanical ventilation in children
Summary
Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system which is triggered by either infectious or noninfectious factors [1]. Clinical features of pediatric GBS have been well characterized in a number of different countries [4,5,6,7,8,9]. Symptoms began within 8 days after a preceding infection, cranial nerve involvement, a cerebrospinal protein level > 800 mg/L during the first week, HFGS at nadir, respiratory distress and hypotension were found to serve as predictors for mechanical ventilation [13,14]. The clinical characteristics of pediatric GBS have been extensively studied, they were scarcely compared with that of adult ones. In 1994, Sarada and colleagues found that childhood GBS was associated with a higher incidence of cranial nerve palsy and had a more acute form of onset than adults.
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