From Decision to Delivery: A Twelve- to Fourteen-Day Interval Before Plasma Exchange in a Child with Ventilator-Dependent Axonal Guillain-Barré Syndrome

Abstract

Background: Guillain–Barré syndrome is the commonest cause of acute flaccid paralysis in children. Plasma exchange is accepted when immunoglobulin fails, but the interval from a treatment decision to its delivery is rarely reported.

Objective: To measure the interval between the written decision to escalate to plasma exchange and the first session, and to re-score instruments left uncomputed during admission.

Methods: This CARE-guided case report audited the de-identified clinical record, preserved stated discordances, and recomputed clinical scores, treatment doses, nutritional estimates, and dated intervals.

Results: An 8-year-old boy presented after limb weakness following a diarrhoeal illness, with motor strength graded 1 in all four limbs. Immunoglobulin 0.4 g/kg/day was given for 5 days. Respiratory failure occurred on hospital day 4 and mechanical ventilation continued for 21 days. Plasma exchange was planned on day 10; the first session was completed between days 22 and 24, giving a decision-to-delivery interval of 12–14 days. Three exchanges were completed and a fourth was cancelled. Re-scoring yielded an Erasmus respiratory insufficiency score of 5 or 6 of 7 and Brighton level 2 rather than 1. Weight fell from 77.8% to 70.4% of the documented ideal weight.

Conclusion: At the last review, the disability score was unchanged from admission. Motor recovery was documented before the earliest possible first exchange, so no treatment effect can be claimed. A 10-item minimum data set is proposed.