Departments of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India.
Departments of Pediatrics, Era's Lucknow Medical College & Hospital, Lucknow, Uttar Pradesh, India.
J Child Neurol. 2021 May;36(6):453-460. doi: 10.1177/0883073820978020. Epub 2020 Dec 17.
To describe the clinical-laboratory profile of pediatric Guillain-Barre syndrome and delineate features associated with need of mechanical ventilation.
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.
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.
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.
描述小儿格林-巴利综合征的临床-实验室特征，并阐明与机械通气需求相关的特征。
在一家三级保健医院进行的前瞻性观察性研究中，根据布莱顿标准，对连续住院的格林-巴利综合征患儿进行临床-实验室评估和神经传导研究。使用单变量和多变量分析比较了需要通气和不需要通气的患者之间的临床-实验室特征。
共纳入 46 名（27 名男性）平均年龄为 69.1±35.2 个月的儿童。47.8%的患儿有前驱感染史，43.5%有球麻痹，41.3%有声音微弱，13%有感觉障碍，39.5%有自主神经功能障碍。87%的病例为四肢瘫痪。入院时 44 名儿童的 Hughes 残疾量表评分>3，出院时 39 名（84.7%）评分>3。最常见的电生理类型为急性运动轴索性神经病（46.5%），其次为急性运动感觉轴索性神经病（39.5%）、急性炎症性脱髓鞘性多发性神经病（7%）和不可兴奋神经（7%）。9 名（19.7%）儿童需要通气，3 名（6.5%）死亡或失访，43 名出院。单变量分析中与机械通气需求相关的因素包括年龄较大、高血压、球麻痹、声音微弱、较低的医学研究委员会（MRC）总分、白细胞总数升高和前驱感染史。Logistic 回归显示，年龄较大、有基础疾病史、MRC 总分较低和球麻痹是小儿格林-巴利综合征机械通气的独立预测因素。
在印度北部儿童中，最常见的电生理亚型为急性运动轴索性神经病。年龄较大、前驱感染、MRC 总分较低和球麻痹是小儿格林-巴利综合征机械通气的预测因素。
