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Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management
Mulugeta Sitot Shibeshi1, Adane Alto Mengesha2, Kefyalew Taye Gari1
1Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia.
Insights
Guillain-Barré syndrome (GBS) in Ethiopian children presents challenges in diagnosis and management. Respiratory failure significantly increases mortality risk, highlighting a critical need for improved care in resource-limited settings.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Guillain-Barré syndrome (GBS) is an acute, immune-mediated peripheral neuropathy with variable outcomes.
- Diagnostic and treatment challenges persist in resource-limited settings.
- This study focuses on pediatric GBS in southern Ethiopia.
Purpose of the Study:
- To describe the clinical presentation of pediatric GBS in southern Ethiopia.
- To identify diagnostic and management challenges.
- To determine hospital outcomes and factors associated with mortality.
Main Methods:
- Retrospective chart review of 102 children (≤14 years) diagnosed with GBS from 2017-2021.
- Data collected on demographics, clinical features, investigations, treatment, and outcomes.
- Logistic regression used to identify mortality predictors.
Main Results:
- Mean age 7.25 years; 63.7% male. Upper respiratory tract infection was the most common trigger (63.8%).
- Cranial nerve involvement (27.5%) and dysautonomia (57.8%) were common. ICU and mechanical ventilator utilization was suboptimal.
- Mortality rate was 12.7%; respiratory failure was the sole significant predictor of death (AOR=11.40).
Conclusions:
- Significant gaps exist in diagnosing and managing pediatric GBS in this region.
- Mortality rates for GBS in this Ethiopian cohort exceed those reported elsewhere.
- Improved diagnostic and management strategies are crucial to reduce GBS mortality in resource-limited areas.
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.
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