Risk factors of respiratory failure in children with Guillain-Barré syndrome.
BACKGROUND
Respiratory failure is rarely associated with Guillain-Barré syndrome (GBS) in children. The aim of the study was to determine the risk factors of respiratory failure in children with GBS to advance management.


METHODS
In this retrospective study, the variables that lead to respiratory failure were investigated in 40 children. The risk factors were compared for 4 children with intubation and 36 without. We also analyzed the specific treatments, including corticosteroids, intravenous immunoglobulin, plasmapheresis, and clinical status at discharge.


RESULTS
Four (10.0%) of the 40 children with GBS required mechanical ventilation. The need for mechanical ventilation was significantly related to the Hughes score at nadir (p<0.001), respiratory distress (p<0.001), and hypotension (p<0.001). Atypical presentation of symptoms such as croup, hoarseness, vomiting, ataxia, consciousness disturbance, and previous event of diarrhea were more predominant in patients younger than 6 years. Disability grades >3 at discharge were found in 15 patients (37.5%), and there was no mortality in the present case series.


CONCLUSIONS
Respiratory failure in childhood GBS was related to the Hughes score at nadir, respiratory distress, and hypotension. Atypical presentations of symptoms were more predominant in patients younger than 6 years. The prognosis in our series was good and not related to previous events. Understanding the risk factors of severe GBS will provide better treatment strategies and improve the outcomes.
Department of General Pediatric, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Mei-Hua
MH
Hu
Chiung-Mei
CM
Chen
Kuang-Lin
KL
Lin
Huei-Shyong
HS
Wang
Shao-Hsuan
SH
Hsia
Ming-Liang
ML
Chou
Po-Cheng
PC
Hung
Chang-Teng
CT
Wu
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D010956:Plasmapheresis / Q000379:methods; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous