Distinct Clinical Characteristics of Pediatric Guillain-Barré Syndrome: A Comparative Study between Children and Adults in Northeast China

Abstract

Objective: Clinical characteristics of pediatric Guillain-Barré syndrome (GBS) have been extensively studied whereas scarcely been compared with those of adult GBS. Herein we compared the clinical features of GBS between pediatric and adult patients.

Methods: We retrospectively collected the clinical data of 750 patients with GBS (541 adults and 209 children), and compared the clinical characteristics between children and adults.

Results: Pain was a more frequent complaint in children (17.2% vs 9.6%, p < 0.01), who were also found with shorter interval from disease onset to nadir (6.3d vs 7.3d, p < 0.01) and higher incidence of bulbar dysfunction (22.0% vs 14.8%, p < 0.05). The disease severity in children was comparable with adults. In addition, a higher incidence of pediatric GBS was found in summer, especially in July and August (both p < 0.01). However, the incidence of antecedent infections of different seasons in adult and pediatric patients was comparable (p > 0.05). The clinical features of acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) in children were overall comparable with adult ones (p > 0.05). Similar to adults, bulbar dysfunction (odds ratio [OR]: 4.621, 95% confidence interval [CI]: 1.240-17.218, p < 0.05) and lower nadir Medical Research Council (MRC) sum score (OR: 0.897, 95% CI: 0.855-0.941, p < 0.01) were also risk factors for mechanical ventilation in children. However, distinct from adult ones, autonomic dysfunction was significantly higher in mechanically ventilated childhood GBS (39.1% vs 8.8%, p < 0.01), which also served as a predictor for mechanical ventilation in pediatric GBS (OR: 70.415, 95% CI: 9.265-535.158, p < 0.01). As to the efficacy of intravenous immunoglobulin, insignificant difference was identified between children and adults.

Conclusion: The clinical features of pediatric GBS differ from those of adults. Autonomic dysfunction is an independent risk factor for mechanical ventilation in pediatric patients.

Fig 1. Seasonal and monthly variation in the occurrence of Guillain-Barré syndrome (GBS).

The incidence of GBS of pediatric patients in spring, summer, autumn and winter was 13.9%, 51.7%, 24.9% and 9.6%, respectively. Accordingly, it was 24.4%, 36.2%, 24.0% and 15.3%, respectively, in the adult ones (A). Further, the monthly variation in the occurrence of GBS was investigated. The incidence of GBS in children and adult during January to December was 2.4% and 7.6%, 3.3% and 2.4%, 3.8% and 7.8%, 2.9% and 7.6%, 7.2% and 9.1%, 8.6% and 10.0%, 23.4% and 16.1%, 19.6% and 10.2%, 10.5% and 8.5%, 6.2% and 8.7%, 8.1% and 6.8%, 3.8% and 5.4%, respectively (B). In addition, the incidence of antecedent infections in spring, summer, autumn and winter was 64.0%, 64.3%, 66.3% and 68.6%, respectively, in adults with GBS; similarly, it was 72.4%, 60.2%, 70.6% and 65%, respectively, in pediatric GBS (C).

Fig 2. Comparisons between AMAN and AIDP in children.

The incidence of upper respiratory infection (URI) as antecedent infections of AMAN was 21.7% which was insignificantly different from AIDP (28.6%, p > 0.05). Similarly, the incidence of diarrhea in pediatric AMAN was comparable with AIDP (47.8% vs 42.9%, p > 0.05) (A). The interval from onset to admission was 4.2d in children with AMAN, while it was 6.2d for pediatric AIDP, which was significantly different. However, interval from onset to nadir was comparable between AMAN and AIDP (6.2d vs 7.0d, p > 0.05) (B). The MRC sum score at nadir was lower in pediatric AMAN than childhood AIDP (30.5 ±12.0 vs 39.8±11.0, p < 0.05) (C). AMAN: acute motor axonal neuropathy; AIDP: acute inflammatory demyelinating polyneuropathy; URI: upper respiratory infection; MRC: Medical Research Council.