الفهرس 
Title : Course, approach to initial treatment failure and outcome of critically Ill children with guillain barre syndrome
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Abstract
Guillain Barre Syndrome (GBS) is an important cause of pediatric respiratory failure and the most common cause of acute flaccid paralysis in the post-poliomyelitis eradication era. We aimed to determine the benefit of immunosuppressive therapy in children with severe GBS, not improving after first line therapy. Methodology: 40 patients with severe GBS who needed ICU admission for either MV (n=30), bulbar manifestations or rapidly progressive weakness were enrolled and received initial treatment of plasma exchange (PE) sessions or immunoglobulins. Those with initial treatment failure were randomized to receive further PE either alone or with complementary immunotherapy (steroids +/-cyclosporine). Results: Initial treatment was successful in 16 cases (40%) while five patients died. Those with initial treatment failure (n=22) received more PE sessions, of them 15 cases received supplemental steroids. The ability to walk unaided on discharge was regained in 60% of these (n=9/15), vs 28% of those with initial treatment failure who did not receive supplemental immunotherapy (n=2/7). Conclusion: PE with supplemental immunotherapy are proposed to be useful therapies for severe GBS and those with poor initial response