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To evaluate intravenous immunoglobulin (IVIG) therapy in children with very severe Guilain Barre syndrome (GBS) with reference to the need for respiratory support, ICU stay and long-term outcome, we studied 33 children with very severe GBS and quadriparesis and/or respiratory muscle weakness admitted to the Pediatric Intensive Care Unit (PICU) of PGIMER, Chandigarh. Cases (n=22,IVIG group) were enrolled prospectively, and controls (n=11), similar to cases in age and severity of illness, retrospectively. All children received similar supportive and respiratory care. In addition, cases were given IVIG (Sandoglobulin, Sandoz) 0.4 g/kg bodyweight per day for 5 days. The mean age, duration of symptoms prior to admission and severity of illness in the two groups were similar. In the IVIG group, onset of recovery of muscle power was significantly earlier (day 14.8 (6.8) of illness vs day 20.9 (8.6), p 0.05) and the length of PICU stay significantly shorter (20.5 (13.0) days vs 50.5 (33.3) days, p 0.01). Sixteen (72.7%) children in the IVIG group had improved by at least one functional grade after 1 month and 15 (68%) were walking independently after 3 months compared with two (18%) and four (36%) controls, respectively (p 0.05). The number of children who needed endotracheal intubation and mechanical ventilation and the duration of mechanical ventilation was significantly less in the IVIG-treated group. We conclude that in very severe GBS in children IVIG therapy improves outcome to a remarkable extent, reduces the need for intubation and mechanical ventilation, shortens the length of stay in ICU, and promotes ambulation sooner. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barré syndrome (GBS), the most frequent cause of acute flaccid paralysis worldwide, is a post infectious polyradiculoneuropathy. Preceding C. jejuni infection in patients of GBS and its co-relation to various subtypes of GBS have been studied. Methods: 50 patients of GBS were prospectively enrolled from PGIMER, Chandigarh a tertiary care hospital in India between August 2006 and July 2007. These patients were electrophysiologically categorized into subtypes. These patients and 40 age, sex and geographically matched controls were subjected to serology for C. jejuni (IgG and IgM) using ELISA and compared. Results: Evidence of recent C. jejuni infection was present in 30% of GBS patients compared to 8% of controls (15/50 vs 3/40 P<0.005). Preceding events in GBS patients were gastroentritis (32%), upper respiratory tract infection (14%) and fever (12%). 8 (47%) C. jejuni positive patients reported symptoms of gastroentritis (mean 13 days) prior to onset of GBS. 10/15(67%) patients of C. jejuni infection had axonal type of GBS (AMAN &AMSAN). Overall Axonal variety of GBS presented in a younger age group compared to AIDP (mean age- Axonal v/s AIDP- 30.11 + 13.73 v/s 40.2 + 18.77). C. jejuni positive patients presented mainly in spring and winter and had a similar age and sex incidence as compared to the rest of GBS patients. Conclusions: Preceding C. jejuni infection was more common among GBS patients than controls. Preceding C. jejuni infection in GBS patients was more commonly associated with the axonal variety of GBS. [ABSTRACT FROM AUTHOR]