Impact of Immunotherapy Combinations on Clinical Outcomes in Children with Acute Flaccid Paralysis: A Multicenter Intensive Care Study.

OBJECTIVE

Acute flaccid paralysis (AFP) is a syndrome characterized by the rapid onset of limb weakness and decreased muscle tone, frequently accompanied by respiratory or bulbar involvement.

METHODS

This retrospective multicenter study evaluated the clinical characteristics, treatment modalities, intensive care processes, and outcomes of 68 children diagnosed with AFP who were admitted to pediatric intensive care units (PICUs) between January 1, 2018, and January 1, 2023.

RESULTS

The patients' ages ranged from 1 month to 18 years (mean 7.9 ± 4.5 years), and 33 (48.5%) were male. The mean PICU stay was 15.4 ± 19.5 days, and the mean total hospital stay was 23.3 ± 21.1 days. Respiratory support was required in 42 patients (61.8%). All patients received intravenous immunoglobulin (IVIG). Therapeutic plasma exchange (TPE) was administered to 25 of 43 Guillain-Barré syndrome (GBS) patients, 7 of 11 transverse myelitis (TM) patients, and 11 of 14 acute disseminated encephalomyelitis (ADEM) patients. Among 14 intubated GBS patients, 5 received IVIG for ≤2 days and 9 for ≥4 days. The duration of invasive mechanical ventilation (MV) was significantly longer in patients receiving IVIG for ≥4 days (P=.044). Guillain-Barré syndrome patients treated with combined IVIG and TPE had longer PICU stays compared with those receiving IVIG alone (P=.001).

CONCLUSION

Combination immunotherapies were associated with longer MV duration and PICU stay compared with monotherapy in AFP patients. In intubated GBS patients, administration of IVIG over 2 days was associated with a shorter duration of invasive MV.