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Impact of the COVID-19 pandemic on the frequency, clinical spectrum and outcomes of pediatric guillain-barré syndrome in India: A multicentric ambispective cohort study


1 Department of Neurology, Lady Hardinge Medical College, New Delhi, India
2 Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
3 Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Neurology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
5 Kalinga Hospital Limited, Bhubaneswar, Odisha, India
6 Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
7 Department of Neurology, Lalitha Super Specialities Hospital Pvt. Ltd., Guntur, Andhra Pradesh, India
8 Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
9 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
10 Department of Neurology, Ramakrishna Care Medical Sciences, Pvt Ltd, Raipur, Chhattisgarh, India
11 Department of Neurology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
12 Department of Neurology, NH MMI Narayana Superspeciality Hospital, Raipur, Chattisgarh, India
13 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
14 Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
15 Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
16 Department of Neurology, Sardar Patel Medical College, Bikaner, Rajasthan, India
17 Department of Neurology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
18 Department of Neurology, Goa Medical College, Goa, India
19 Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odissa, India
20 Department of Neurology, Army Hospital, Guwahati, Assam, India
21 Department of Neurology, Krishna Institute of Medical Sciences Hospital, Secunderabad, Telangana, India
22 Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
23 Department of Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
24 Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
25 Department of Neurology, Caritas Hospital, Kottayam, Kerala, India

Correspondence Address:
Venugopalan Y Vishnu,
Assistant Professor, Department of Neurology, RN 704, Seventh floor, CN Center, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.aian_392_21

Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75–11.25] years versus 5 (2.5–8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1–3.5) versus 3 (2–4); P = 0.042) and GBS disability score at 3 months (median 0 (0–0.75) versus 2 (0–3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.


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