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Guillain Barré syndrome (GBS; Synonyma: Polyneuritis, Polyradikulitis) is an acute, inflammatory, demyelinating disease of the peripheral nerve system. Clinical hallmarks are symmetric muscle paralysis, areflexia and pronounced autonomic disturbances. Respiratory failure and cardiovascular instability are the main reasons for intensive care support in patients with GBS. We present the process of illness of an 10 month old baby with GBS. The report discusses RSV as possible triggers. For children with ARDS, a nitric oxide ventilation could represent a lifesaving option.

A four-month-old infant was hospitalized because of RSV bronchiolitis. Two days after presentation he developed rhabdomyolysis, most probably as a result of multiple factors (hyperthermia, hypovolemia/dehydration, hypernatremia, metabolic acidosis), followed by severe complications including acute renal failure, hepatic dysfunction and disseminated intravascular coagulation. Under sufficient fluid supply he recovered completely. In rhabdomyolysis clinical symptoms vary. Seldom, the classical trial of muscle pain, weakness, and dark urine is observed. Severe complications are hypovolemia, electrolyte disorders, a compartment syndrome, disseminated intravascular coagulation and acute renal failure, which causes death in 20% of the patients, although non-traumatic causes seem to have better outcome. The mainly therapeutic option is to correct the hypovolemia with sufficient fluid supply.

From 1974 until April 1977 232 babies with acut bronchiolitis were hospitalized at the Landeskinder-krankenhaus Linz. They represented 8% of all babies admitted to the ward during this period. 9 (= 3,9%) of these were sucessfully mechanically ventilated because of respiratory failure. A pCO2 level above 60 mm Hg was taken as an sign of respiratory insufficiency. By application of artificial ventilation mortality rate of acut bronchiolitis can further be decreased.

Apart from cigarette smoking and air pollution, lower respiratory tract infections of viral origin in early childhood are considered to be one of the risk factors for chronic obstructive lung disease. Acute bronchiolitis accounts for the typical disease of the small airways in the first two years of life. 16 symptom-free former patients have been studied 16 to 22 years after an acute attack of bronchiolitis. A complete lung function test was performed with special regard to the small airways. The volume of Isoflow proved to be the most sensitive test. The changes found are considered to be mild. Follow-up will show whether they correlate with an as yet symptom-free stage of a chronic obstructive lung disease.

Report of an 1 1/2 year old boy with the typical features of Williams-Campbell syndrome: chest deformity (thorax piriformis), pulmonary hyperinflation, ballooning of the segmental and subsegmental bronchi during inspiration and collapse with expiration. Atelectasis of the left upper lobe after bronchiolitis obliterans. The literature reports 23 patients with Williams-Campbell syndrome. There is every reason to believe that the extensive bronchiectasis are not due primarily to developmental deficiency of the bronchial cartilage, as the most authors assume, but result from destructive changes after inflammation. In our case very likely an adenovirus infection was the cause. The clinical features of the syndrome look like a severe therapy resistant asthma bronchiale.

Inspiratory or exspiratory stridor associated with dyspnea represents a common pediatric symptomatology compatible with various diseases which usually are of infectious etiology. The causative obstruction of the infantile airways may lead to life-threatening respiratory failure. A review is conducted of the most important emergencies characterized by stridor and dyspnea in early childhood: croup syndromes (acute viral laryngotracheitis, spasmodic croup, bacterial tracheitis), epiglottitis and bronchiolitis.