| Objective: We summarized clinical feature and assessed clinical predictors for mechanical ventilation in children with Guillain-Barré syndrome(GBS)in order to early recognize severe patients who require mechanical ventilation.Methods: We retrospectively collected the clinical,laboratory and electrophysiological data of 103 children with GBS who were treated in Children's Hospital of Chongqing Medical University between January 1,2014 and December 31,2018.Their clinical characteristics were summarized.Then,patients were categorized into two groups based on the requirement for artificial ventilation.Variables that were significantly different between the two groups in univariate analysis were analyzed by multivariate logistic regression models.Results: A total of 103 children with GBS were enrolled,with 62 males and 41 females.The mean age of onset was 5.4±3.4 years(range 0.8-14.3 years).Antecedent events were found in 73 cases(70.9%)with a predominance of upper respiratory tract infection(46.6%).The median time from symptom onset to admission was 7 days(1-23 days).Weakness(69.9%)and lower extremities pain(16.5%)were the most common symptoms of onset.Of the 103 cases,89(86.4%)could not walk independently at admission(Hughes' GBS disability scale ?3),50(48.5%)had cranial nerves involvement,31(30.1%)had dysautonomia,67(65.0%)had sensory symptoms,24(23.3%)had respiratory muscle weakness and 8(7.8%)had normal tendon reflex or even hyperreflexia.All patients had a normal serum albumin level before immunotherapy.Among 100 patients who underwent lumbar puncture,85 cases(85.0%)showed cytoalbuminological dissociation in cerebrospinal fluid(CSF).In nerve conduction studies,68 of 103 cases(66.0%)showed demyelinating features whereas 31 of 103 cases(30.1%)were divided into axonal type.15(14.6%)and 88 cases(85.4%)were classified into mechanical ventilation group and non mechanical ventilation group,respectively.Time from symptom onset to admission(P=0.002),cranial nerve involvement(P=0.001),and axonal type(P=0.004)were associated with mechanical ventilation in univariate analysis.In mechanical ventilation group,the median time from symptom onset to admission was 3 days,86.7% had cranial nerve involvement,and axonal type was more frequently observed in nerve conduction studies.Whereas in non mechanical ventilation group,the median time from symptom onset to admission was 7 days,42.0% had cranial nerve involvement,and peripheral nerve demyelination was more common in nerve conduction studies.The cranial nerve involvement(OR=7.159,95%CI: 1.371-37.395;P=0.020)and axonal type(OR=5.147,95%CI: 1.410-18.784;P=0.013)were independent predictors for mechanical ventilation in Logistics regression analysis.Conclusion: Males were more susceptible in children with GBS.Most of them had antecedent infection.Pain was usually observed in clinical presentation.A few patient had normal tendon reflex or hypereflexia.A majority of patients had albuminocytologic dissociation in cerebrospinal fluid.But this phenomenon was closely related to the clinical course.The demyelination of peripheral nerve was more predominant in nerve conduction test.Cranial nerve involvement and axonal type were associated with increased risk for mechanical ventilation in children with GBS.Meanwhile,a short time from symptom onset to admission usually indicates a rapid progression.These patients need to be intensively monitored and early treated... |
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