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Long-Term Neurological, Behavioral, Functional, Quality of Life, and School Performance Outcomes in Children with Guillain Barre Syndrome Admitted to PICU

      Abstract:

      Background

      /Objective: Most children with Guillain-Barre syndrome (GBS) recover but may suffer from long-term sequelae, interfering with development and quality of life. Due to the lack of published data, we aimed to assess the long-term neurological, behavioral, functional, quality of life, and school performance outcomes in children with GBS.

      Methods: Design

      Cross-sectional observational. Setting: Pediatric intensive care unit. Patients: Children, 1-12 years of age, with GBS, admitted over five years (July 2012 to June 2017) were prospectively enrolled during one year (July 2017 to June 2018). They were assessed for the following outcomes: neurological [Hughes disability score, Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and Glasgow Outcome Scale-Extended Pediatric version (GOS-E Peds) scales]; behavioral [Childhood Psychopathology Measurement Schedule (CPMS)], functional [Vineland Social Maturity Scale (VSMS)-Indian Adaptation], quality of life [Pediatric quality of life (PedsQL)] and school performance (Parent-directed questionnaire).

      Results

      Eighty children were enrolled after a median of 3.0 (1.3-4.2) years from discharge. The majority (95%) had favourable neurological recovery (Hughes disability score 0-1). Favourable outcome was noted in 95% of children on PCPC, 87.5% on POPC, 60% on GOS-E Peds, 86.2% on CPMS, 92.5% on VSMS, and 98% on PedsQL. The majority (97.5%) were attending schools, and 57.7% had satisfactory school performance. The presence of quadriparesis at admission, mechanical ventilation and tracheostomy requirement, poor ambulatory status at discharge, and longer PICU and hospital stay were predictors of unfavourable neurological outcome on different tools. Absence of quadriparesis at admission and no requirement of mechanical ventilation predicted a favourable result on all outcome measures.

      Conclusions

      On long-term follow-up, most children with severe GBS showed favourable neurological, behavioral, functional, and quality of life outcomes. Severe clinical presentation and prolonged ICU stay predict poor long term outcome.

      Keywords

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