Objective To investigate the spectrum of complications and the factors associated with morbidity in children with Guillain–Barré syndrome (GBS) admitted to a paediatric intensive care unit (PICU).
Methods Records of children admitted to a PICU between 1998 and 2007 with a diagnosis of GBS were retrospectively reviewed. Demographic characteristics, length of PICU stay, clinical severity of GBS (Hughes score), occurrence and duration of mechanical ventilation were emphasised. Complications were defined on the basis of severity, as major morbidity (respiratory, infectious and miscellaneous morbidity), minor morbidity (hyponatremia <130 mmol/l, hyperglycaemia requiring treatment) and any morbidity. Associations between patient characteristics and major morbidity were assessed by non-parametric tests.
Results Thirty-two patients were included (age 5.5 ± 3.4 years, length of stay 18.4 ± 16.3 days). The reason for PICU admission was neuromuscular respiratory failure in all cases. Twenty patients (62.5%) required mechanical ventilation (duration 24.3 ± 14.2 days). Tracheotomy was performed in two patients (6.2%). Intravenous immunoglobulin was given in 56.3% of patients. Major morbidity occurred in 56.2% of patients. Pneumonia was the most common cause of morbidity, occurring in half of patients followed by hyponatremia (28.1% of patients). Factors associated with major morbidity were: clinical severity of GBS (p = 0.000), prolonged mechanical ventilation more than 14 days (p = 0.005) and prolonged duration of stay more than 21 days (p = 0.028).
Conclusion The morbidity of GBS admitted to the PICU is dominated by pneumonia. Attention to the management of mechanical ventilation is important to minimise this complication of GBS.