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

Abstract

Background

Guillain–Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia.

Methods

A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality.

Results

The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009].

Conclusion

There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.

Keywords:

• Guillain–Barre syndrome
• outcome
• resource limited setting

Abbreviations

AFP, acute flaccid paralysis; GBS, Guillain Barre syndrome; CSF, cerebrospinal fluid; ICU, intensive care unit; SPSS, Statistical Package for Social Sciences; IVIG, intravenous immunoglobulin; MV, mechanical ventilation; IQR, interquartile range; NCS-EMG, nerve conduction study-electromyography.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

The authors are grateful to all individuals who participated in the data collection.

Author Contributions

All authors contributed significantly to this work in the conception, study design, execution, data acquisition, analysis, and interpretation; participated in the drafting, revising, or critical review of the article; gave final approval of the version to be published; agreed on the journal to which the article will be submitted; and agreed to be responsible for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.