Clinical profile and outcome of snakebite in children at tertiary care centre in Hyderabad, India: a hospital based prospective observational study

Abstract

Background: Snakebite is generally considered medical emergencies in many parts of the world, particularly in the rural population, and has been linked with the environmental and occupational conditions. Agricultural workers and pediatric groups are most affected in Southeast Asia especially India. This study was conducted to analyze the clinical profile, complications, and outcome of snakebite that will help in the prevention and treatment intervention in the pediatric population.

Methods: The present study was conducted at the pediatric tertiary center, Niloufer Hospital, Osmania Medical College, Hyderabad, India during the period of 1 year from January 2019 to December 2019. A total of 59 cases of snakebite were admitted to the pediatric department during the study period. After obtaining consent, data were analyzed for demographic data and other variables included are the site of the bite, time of the bite, time of arrival to hospital and type of snake, features of hematotoxicity and neurotoxicity, ASV requirement, complications, and outcome.

Results: Out of a total of 59 patients, 55.93% were male and most of the Snakebites were seen in the age group of 7-12 years. Clinically 48(81.35%) patients presented with signs and symptoms of envenomation and most of them were bitten during the months of June to July. Greater number of bites were unknown Snakebites and lower limb(57.62%) was the commonest site of the bite. Most of the Snakebites i.e. 23(38.98%) happened during evening time and 15 (25.42%) cases during night time. Most of the patients were primarily treated by medical personnel. Majority of patients (32.03%) developed clinical manifestations in 30 min to 1-hour duration followed by 13 cases (22.03%) within 30 min. Majority of patients (38.98%) arrived at the hospital in 3-6 hours. During hospital treatment, 79.66% of victims received anti-snake venom (ASV). Mechanical ventilation required in 12 cases (20.33%) in which the majority of cases (8.47%) were unknown Snakebites. The most common complication was cellulitis (20.33%) followed by respiratory paralysis/coma (15.25%) and coagulopathy (6.77%). Abdominal pain was observed in 11 (18.64%) cases and Abdominal pain was co-existed with neuromuscular paralysis ( 90.90%). Acute kidney injury was seen in 1 case (1.69%).

Conclusion: The most endangered group of children for Snakebites are boys aged more than 6 years. As most of the bites take place in lower limbs during evening hours, avoidance of outdoor activities, and protective clothing may significantly reduce the incidence of Snakebites. The presence of abdominal pain followed by neurotoxicity suggesting that pain abdomen is a potentially early feature of snakebite envenomation. Community education about prevention and first aid treatment, early transport, and admission in a hospital with good equipment will reduce the mortality from the snakebite