Intravenous immunoglobulin in very severe childhood Guillain-Barre syndrome

To evaluate intravenous immunoglobulin (IVIG) therapy in children with very severe Guilain-Barre syndrome (GBS) with reference to the need for respira tory support, ICU stay and long-term outcome, we studied 33 children with v ery severe GBS and quadriparesis and/or respiratory muscle weakness admitte d to the Pediatric Intensive Care Unit (PICU) of PGIMER, Chandigarh. Cases (n = 22, MG group) were enrolled prospectively, and controls (n = 11), simi lar to cases in age and severity of illness, retrospectively. All children received similar supportive and respiratory care. In addition, cases were g iven IVIG (Sandoglobulin, Sandoz) 0.4 g/kg bodyweight per day for 5 days. T he mean age, duration of symptoms prior to admission and severity of illnes s in the two groups were similar. In the IVIG group, onset of recovery of m uscle 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 w ho needed endotracheal intubation and mechanical ventilation and the durati on of mechanical ventilation was significantly less in the IVIG-treated gro up. We conclude that in very severe GBS in children IVIG therapy improves o utcome to a remarkable extent, reduces the need for intubation and mechanic al ventilation, shortens the length of stay in ICU, and promotes ambulation sooner.