Axonal Versus Demyelinating Guillain-Barré Syndrome Subtypes in Critically Ill Children: Clinical and Autonomic...

Electrophysiological subtypes of Guillain-Barré Syndrome (GBS) vary in pathophysiology and clinical presentation, but comparative data on their intensive care needs in critically ill children remain limited.

In this retrospective cohort study, we analyzed 224 children (1 month to 12 years) diagnosed with GBS and admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in North India from January 2010 to December 2022. GBS was subtyped based on nerve conduction studies into acute motor axonal neuropathy (AMAN), acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor-sensory axonal neuropathy (AMSAN), inexcitable, or equivocal patterns. Clinical features, intensive care interventions, and outcomes were compared across subtypes.

AMAN was the most common subtype (61.6%), followed by AIDP (20.1%) and AMSAN (8%). A prodromal illness was reported in 47.3% of cases. Mechanical ventilation was required in 54.9%, and tracheostomy in 24.2% of children. AMSAN was associated with a significantly longer duration of symptoms at presentation (P = 0.006). Autonomic instability, particularly hypertension (P = 0.04), was significantly more frequent in the AIDP group. However, Hughes disability scores, respiratory and cranial nerve involvement, and intensive care needs were similar across subtypes.

AMAN was the predominant GBS subtype in critically ill children. While AMSAN was associated with delayed presentation and AIDP with greater autonomic dysfunction, overall intensive care needs and short-term outcomes were comparable across subtypes.