Pediatric Guillain–Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome

Figures & data

Table 1 Brighton Criteria Level of Diagnostic Certainty of GBS

Variables	Level 1	Level 2	Level 3	Level 4
Bilateral and flaccid weakness of limbs	+	+	+	±
Decreased or absent deep tendon reflexes in weak limbs	+	+	+	±
Monophasic course and interval between onset and nadir 12 hours to 28 days and subsequent clinical plateau	+	+	+	±
Albuminocytological dissociation (CSF protein level above normal value and CSF cell count < 50 cells/μL)	+	±	-	±
Electrophysiologic findings consistent with GBS	+	±	-	±
Absence of an alternative diagnosis for weakness	+	+	+	+

Table 2 Demographic and Clinical Characteristics of Children with GBS (n = 102)

Variables	Category	Frequency
Age(years), mean ± SD		7.25±3.91
Sex, n(%)	Male	65(63.7)
	Female	37(36.3)
Age(years)	<5	36(35.3)
	5–9	32(33.3)
	10–14	34(31.4)
Residence	Urban	32(31.4)
	Rural	70(68.6)
Season of onset	December-February	16(15.7)
	March-May	26(25.5)
	June-August	28(27.5)
	September-November	32(31.4)
Antecedent event present	Yes	49(48)
	No	53(52)
Antecedent event	URTI	30(61.2)
	AGE	12(24.5)
	URTI&AGE	5(10.2)
	Anti-rabies vaccine	1(2)
	Malaria	1(2)
Pain	Present	62(60.8)
	Absent	40(39.2)
Hughes disability score(mean)	At presentation	4.23 ± 0.54
	At nadir	4.48 ± 0.71
	At discharge from hospital	4.03 ± 0.86
Cranial nerve involved	Bulbar palsy	26(92.8)
	CN7 palsy	1(3.6)
	Both bulbar and facial	1(3.6)
Patient needed ICU care	Yes	63(61.8)
	No	39(38.2)
Percentage that got ICU care from those in need (N=63)	Yes	43(68.3)
	No	20(31.7)
Dysautonomia	Yes	59(57.8)
	No	43(42.2)
CSF analysis done	Yes	63(61.8)
	No	39(38.2)
CSF analysis typical of GBS(n=63)	Yes	50(79.4)
	No	13(20.6)
Treated with IVIG	Yes	6(5.9)
	No	96(94.1)
Patients that required mechanical ventilation	Yes	31(30.4)
	No	71(69.6)
Percentage that received respiratory support (N= 31)	Yes	24(77.4)
	No	7(22.6)
Antibiotic treatment	Yes	36(35.3)
	No	66(64.7)
Outcome at discharge from hospital	Improved	45(44.1%)
	Same	41(40.2)
	Worsened*	3(2.9)
	Died	13(12.7)

Note: *Worsened compared to condition at admission.

Abbreviations: AGE, acute gastroenteritis; CN7, cranial nerve 7; ICU, intensive care unit.

Table 3 Logistic Regression Analysis Results of Factors Associated with Mortality in Children with GBS (N = 102)

Variable	Category	COR (95% CI), p	AOR (95% CI), p
Deep tendon reflexes	Diminished	0.07(0.02, 0.27), <0.001	0.29(0.04, 2.04), 0.22
	Absent	1	1
Cranial nerve involvement	Present	23.29(4.72,114.99),<0.001	19.79(0.26, 1483.64), 0.18
	Absent	1	1
ICU admission	Yes	5.66(1.45,22.04), 0.013	0.39(0.02, 6.87), 0.52
	No	1
Respiratory failure	Present	22.13(5.51,88.96), <0.001	11.40(1.818,71.52), 0.009
	Absent	1
Dysautonomia	Present	11.22(1.40,89.96), 0.023	5.50(0.26,98.59), 0.29
	Absent	1
Mechanical ventilation	Yes	11.10(3.02,40.81), <0.001	0.33(0.003,35.82), 0.64
	No	1
Duration of paralysis before presentation		0.79(0.62, 0.99), 0.044	0.84(0.53, 1.31), 0.44

Note: 1: Reference.

Abbreviations: COR, crude odds ratio; AOR, adjusted odds ratio; ICU, intensive care unit; P, p-value.