Clinico-epidemiological profile and prediction of outcome in children with Guillain-Barre syndrome.

Abstract

Background: Guillain-Barré Syndrome (GBS) is a rare but serious immune-mediated neuropathy characterized by acute-onset motor weakness and potential respiratory failure. Its pathogenesis often involves molecular mimicry triggered by antecedent infections, leading to autoimmune targeting of peripheral nerves. Epidemiological data suggest a correlation between infectious outbreaks and increased GBS incidence, as exemplified by the 2025 surge in cases associated with Campylobacter jejuni enteritis in Pune, India.

Methods: This prospective observational study was conducted over 24 months in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Ethical approval was obtained. Consecutive enrolment included children aged 2-14 years diagnosed with GBS who presented within two weeks of symptom onset. Comprehensive clinical, electrophysiological, and treatment data were collected. Patients were prospectively followed for six months, and outcomes were assessed using the GBS Disability Score. The modified Erasmus GBS outcome Score (mEGOS) and Erasmus GBS Respiratory Insufficiency Score (EGRIS) were applied for prognostic evaluation.

Results: The study cohort comprised 27 children, with males aged 5-9 years being the most commonly affected. The mean (± SD) age was 6.56 (± 3.00) years. All participants reported antecedent illnesses, predominantly gastroenteritis. Clinically, symmetric motor weakness was observed in 81.5%, and 77.8% exhibited sensory involvement. Respiratory compromise requiring mechanical ventilation occurred in 11.1% of patients. Electrophysiological studies identified acute motor axonal neuropathy (AMAN) as the predominant variant, with acute motor sensory axonal neuropathy (AMSAN) demonstrating more severe clinical courses, including higher ventilation requirements and poorer functional outcomes. Prognostic assessment revealed median (IQR) mEGOS scores of 5 (4,6) at admission and 4 (3,6) at 1-week post-admission. These scores significantly predicted outcomes at 4 weeks, 3 months, and 6 months, with higher scores correlating with greater disability. The cohort's mean EGRIS score was 5.67, with higher scores predictive of increased mechanical ventilation requirements.Notably, all patients achieved favourable outcomes with no mortality, highlighting the effectiveness of the implemented management protocol.

Conclusion: Our findings demonstrate that mEGOS and EGRIS are effective prognostic tools in pediatric GBS. The mEGOS reliably predicts functional outcomes at multiple recovery stages, while the EGRIS is particularly useful in early identification of patients at risk for respiratory failure requiring mechanical ventilation.