Snake Bite In Children Research Articles

Clinico-epidemiological profile of snake bite in children in a tertiary care hospital, South India

Clinico-epidemiological profile of snake bite in children in a tertiary care hospital, South India

Venomous Snake Bite in Children: A Case Report from Nigeria

Venomous Snake Bite in Children: A Case Report from Nigeria

A clinical profile of poisonous snake bite in children of North Kerala, India

Background: Snake bite is a common medical emergency and underestimated public health problem causing significant morbidity and mortality worldwide. Poisonous snake bite is a common problem in north Kerala and a significant number of children are bitten by snakes every year. Majority of studies in this respect have been done on adult snake bite victims and only limited studies are available based on poisonous envenomation in children in our region. The clinical profile of snake bite in children can differ significantly from adult snake bite victims so study was conducted to find the clinical profile of poisonous snake bite in children less than fifteen years.Methods: This was a descriptive cross sectional study conducted in a tertiary care academic institution located in the northern part of Kerala from December 2009 to November 2010. All children less than 15 years with poisonous snake bite were included in this study. Patients with non-poisonous bite, without signs of envenomation and with pre-existing bleeding and renal disorders were excluded.Results: There were fifty cases of poisonous snake bite and among them 76% were males and 24% were females. The highest numbers of bites (50%) occurred in the age group between 11-15 years. Maximum number of snake bite occurred during the months of June and July. The majority of the bites occurred during night between 6 pm to 9 pm (42 %). Among the identified venomous bite Viper accounted for the highest number (48%), followed by Krait (12 %) and Cobra (4%). Lower extremities were the most observed bitten part of the body (82%) and the commonest site was foot. Eighty four percentage of victims reached hospital within 6 hours of snake bite. The most common clinical manifestation was local pain (94%) followed by swelling (90%) and regional lymphadenopathy (82%). Majority had hemotoxicity (94%) and neurotoxicity (6%) was comparatively lesser in our study. Most common complication was overt bleeding manifestations (14%) followed by gangrene of bite site (8%), acute kidney injury (6%) and respiratory paralysis (2%). Thirty eight percent of cases required more than 10 vials of ASV and reaction to ASV occurred in 40% of cases. No mortality occurred during this study period.Conclusions: Poisonous snake bite is a common life threatening medical emergency in our region. Morbidity and mortality due to this can be reduced by early administration of anti-snake venom and prompt recognition and management of complications. So, prompt referral of children with poisonous snake bite to centres where facilities in managing snake bite is crucial in preventing mortality.

A descriptive epidemiological study of snake bite cases among children in Eastern Nepal

Introduction: Snake bite is a significant health issue globally. In Nepal, WHO has estimated more than 20,000 snake bites occurring annually. The prevalence of snake bite in children in Nepal has not been specified yet due to relatively few researches. This study explores the epidemiological data on snake bite among children below 18 years of age from a snake bite treatment center located at Itahari in the eastern part of Nepal.Methods: This is a descriptive study of the secondary data from treatment records of snake bites among children up to 18 years of age in Samudayek Sarpadansa Upachar Kendra, Itahari, Nepal. The center is located in Army Camp in the eastern plains of Nepal and provides treatment services to all snake bite victims. Recorded data of the patients brought in for treatment in the treatment center from October 2015 to October 2016 were segregated for age group 0 to 18 years and analyzed.Results: Among 395 cases of snake bite in children below 18 years of age, 57% were boys and most were between 11-15 years. The peak season of bite was during monsoon with clustering of 44% cases from 6 PM to 12 AM and lower limb was the most common site of bite. A total of 7.1% of snake bite cases needed treatment with anti-snake venom.Conclusion: Snake bite among children below 18 years of age is more common among boys, especially during monsoon and evenings. Only small portion of snake bites require treatment with anti-snake venom.

Clinico-epidemiological profile of snake bite in children in a tertiary care centre: a hospital based study

Background: Snake bite remains major public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study was conducted to evaluate the clinico-epidemiological profile and complications of snake bite in children at our institute.Methods: This was a retrospective case record based study with records between January 2011 and December 2016 studied. The clinico-epidemiological features and complications were recorded and analysed.Results: Total of 242 snake bite children were admitted during the study period out of 17512 admissions constituting to 1.38% of admissions. There was male predominance with ratio of 2:1. About 43% of children were in the age group of 7-12 years, followed by 13-18 years. About 43% of bites occurred between March and June months. About 2/3rd of cases were from rural areas, 50% of cases were bitten outdoor. About 3/4th of cases had bite in the lower extremity. In this study 3/4th of children presented to hospital within 6 hours of bite. The major symptoms were pain and swelling at the site of bite. 10% of children had neurotoxic symptoms. Major complications noted were compartment syndrome, DIC, AKI and respiratory paralysis. Four (1.7%) children died, 3 had DIC and 1 died due to uremic encephalopathy.Conclusions: Snake bite remains a major health problem in children causing significant morbidity and mortality. Children are particularly vulnerable because of their active and explorative nature and they also spend considerable time outdoors particularly male children. Simple preventive measures to be taken and people should be educated about avoiding traditional first aid methods and early presentation to hospital.

Snake bite in Children: A retrospective study in a tertiary care centre in Southern India

Snake bite in Children: A retrospective study in a tertiary care centre in Southern India

Clinical profile and outcome of snake bite in children

Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem. This study was conducted to ascertain clinical profile, complication and outcome of snake bite in pediatric population. Methods:Retrospective observational study was done in paediatrics wards and Paediatric Intensive care unit of tertiary care institute. A medical record files of 80 patients of snakebite, between the periods of January 2011 to February 2016 were recovered from Medical Record and Statistics Section of Institute. Files were analyzed for demographic data; variables included site of bite, time of bite, type of primary treatment and treatment provider, and type of snake poison, common symptoms suggestive of hematotoxicity, myotoxicity and neurotoxicity.Results: Out of total 80 patients, 58.75% were male and most of snake bites were seen in age group of 6-12 years. Clinically 57.5% patients were presented with signs and symptoms of envenomation and most of them were bitten during the months of June to September. All bites were nonprovocative and in 57.5% lower limb was the commonest site of bite. A 77.5% patient were primarily treated by medical personnel, 56.25% patients were received treatment within 1 hour of bite and hospitalized within 6 hours of bite. Coagulation failure was commonest complication (58.33%) followed by hypotension (25%) in vasculotoxic snake bite and respiratory paralysis (68.18%) in neuroparalytic bites. Renal replacement therapy was required in 5%, blood/blood product transfusion in 11% patients and case fatality rate was 11.25%.Conclusions: The most vulnerable to snake bites are boys aged more than 5 years. There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

Evaluation of Risk Factors and Follow-Up Criteria for Severity of Snakebite in Children.

BackgroundSnakebites are an emergency medical condition and require rapid treatment procedures in children.ObjectivesThis study aimed to present an overview of the demographic characteristics, clinical presentations, laboratory findings, severity, and complications that developed in pediatric patients due to snakebites.Patients and MethodsA total of 151 children with snakebite were enrolled in the study. All patients had a history of snakebite obtained between June 2006 and August 2015 retrospectively.ResultsDuration of hospitalization (P < 0.001), rural occurrence (P < 0.001), white blood cell (WBC) count (P = 0.002), aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio (P = 0.010), hypoproteinemia (P = 0.001), hypoalbuminemia (P < 0.001), and hypocalcemia (P = 0.005) were significantly high in the severe snakebite group. WBC (P = 0.006) and AST/ALT ratio (P = 0.018) were significantly higher on the first day of the snakebite than on subsequent days.ConclusionsChildren admitted to the hospital due to snakebite should be monitored for at least 24 - 48 hours even if no signs of clinical envenomation could be observed. According to the severity of the disease, antivenom should be administered to the patients. Duration of hospitalization, rural occurrence, WBC count, AST/ALT ratio, CK, hypoproteinemia, hypoalbuminemia, and hypocalcemia can be associated with the severity of snakebite. WBC AST/ALT ratio can be used as follow-up criteria in children with snakebite

Venomous snakebites in children in southern Croatia

This retrospective study represents observation of 160 children and adolescents aged up to 18 years that experienced venomous snakebites in southern Croatia and were treated in the Clinical Department of Infectious Diseases in the University Hospital Centre Split from 1979 to 2013. The main purpose of this research was to determine the epidemiological characteristics, clinical presentation, local and general complications, and received treatment. Most bites occurred during warm months, from early May to late August (80%), mostly in May and June. Upper limb bites were more frequent (59%) than lower limb bites (40%). Out of the total number of poisoned children, 24% developed local, and 25% general complications. The most common local complications were haemorrhagic blisters that occurred in 20% children, followed by compartment syndrome presented in 7.5% patients. The most dominated general complication was cranial nerve paresis or paralysis, which was identified in 11.2% patients, whereas shock symptoms were registrated in 7% children. According to severity of poisoning, 9.4% children had minor, 35% mild, 30.6% moderate, and 24.4% had severe clinical manifestation of envenomation. Only one (0.6%) child passed away because of snakebite directly on the neck. All patients received antivenom produced by the Institute of Immunology in Zagreb, tetanus prophylaxis as well, and almost all of them received antibiotics, and a great majority of them also received corticosteroids and antihistamines. Neighter anaphylactic reaction nor serum disease were noticed in our patients after administrating antivenom. A total of 26% children underwent surgical interventions, and incision of haemorrhagic blister was the most common applied surgical treatment, which was preformed in 15.6% patients, while fasciotomy was done in 7.5% subjects. All of our surgically treated patients recovered successfully.

Clinico-Epidemiological Profile and Outcome of Poisonous Snake Bites in Children using the WHO Treatment Protocol in Western Nepal

Background: Snake bite among children is an important public health problem in many tropical and subtropical countries. Limited studies are found on snake-bite in Nepal using the WHO snake-bite management guidelines. This study assessed the clinico-epidemiological profile and their outcome in snake-bite among children using the WHO Guidelines for treatment of snake bite.Methods: This is a descriptive study among 75 children less than 14 years of age admitted in Emergency Room (ER) of Lumbini Zonal Hospital from 2011-2012 with the history of poisonous snake bite.Results: More than half (56%) of the cases were males and 3/5th (58%) were above 10 years of age. About 40% of the patients were brought to ER within 6-12 hrs of snake bite. Common site of snake-bite was lower limbs (32%) followed by upper limbs (29%). Abdominal Pain (44%) was observed as most common sign/symptom of snake-bite poisoning after local pain followed by ptosis (17.3%). The case fatality rate (CFR) was 16.0%.Conclusion: Use of WHO treatment guideline for snakebite case management among children showed low CFR. However further studies need to done to compare the treatment outcomes between WHO guideline and the National Guidelines among snakebite cases among children. Journal of Nobel College of Medicine Vol.4(1) 2015: 21-25

Lack of Coagulopathy After Copperhead Snakebites

We determine the frequency and severity of abnormal laboratory measures of coagulation after suspected or known copperhead (Agkistrodon contortrix) envenomation. We identified the charts of venomous snakebites in children presenting to St. Louis Children's Hospital over a period of time greater than 14 years and of all venomous snakebites in adults presenting to Barnes-Jewish Hospital over a period of time greater than 11 years. We identified all known or suspected copperhead snakebites. We excluded bites by rattlesnakes, cottonmouths, unidentified snakes, and captive or non-native snakes. We classified the confidence that the culprit was a copperhead snake as "positive" or "probable," according to the previously published criteria. We recorded the most extreme values for laboratory measures of coagulation for each patient. The final data set included 106 venomous snakebites, of which 45 were positively identified as attributable to copperheads and 61 probable copperheads. Results for international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, and fibrinogen concentration remained within normal limits for 79%, 93%, 95%, and 91% of patients, respectively. The highest INRs and PTTs were 1.35 and 41 seconds, respectively, in different patients. Three patients had platelet counts below 100,000/mm(3) (54,000, 75,000, and 76,000/mm(3), respectively). The lowest fibrinogen concentration was 117 mg/dL. Five patients had 2 laboratory values outside normal ranges, and 1 had 3 abnormal laboratory values. No patient developed bleeding complications. In identified copperhead snakebites, it may be safe to forgo serial coagulation testing in both adult and pediatric patients in the absence of clinical evidence of bleeding.

Coral Snake Bites and Envenomation in Children

North America is home to 2 families of venomous snakes, Crotalinae (pit viper family) and Elapidae (coral snake family). Although there are several published reports describing and reviewing the management of pit viper snakebites in children, there are no recent similar publications detailing the clinical course and management of coral snake envenomation. Our case series describes the hospital course of children with coral snake bites admitted to our regional pediatric intensive care. We also reviewed prior published case reports of coral snake bites in the United States. We identified 4 patients with either confirmed or suspected coral snake envenomation from our hospital's records. In 2 cases, the snakebite occurred after apparent provocation. Antivenom was administered to 3 patients. The regional venom response team was consulted for management advice and supplied the antivenom. One patient had a prolonged hospital course, which was complicated by respiratory failure, bulbar palsy, and ataxia. All survived to discharge. Admission to pediatric intensive care is warranted after all Eastern coral snake bites. A specialized regional or national venom response team can be a useful resource for management advice and as a source of antivenom.

Snake bites in children.

Sir, the recent report on snake bites in children is very interesting [1]. Berdai et al. concluded that “immunotherapy adapted to the local species must be made available to improve the prognosis of this envenomation [1].” We would like to share our experience from Thailand, a tropical country with a high prevalence of snake bites. In fact, the use of antivenom immunotherapy might be an effective means for managing patients with envenomation. However, it also poses risks. Not all patients require [...]

About Snake bites in children at the Fez University Hospital (Morocco)

The author stresses the importance of the specificity of immunotherapy and identifies the two appropriate antivenoms for North Africa and the Middle East in general, and Morocco in particular. Due to the very good tolerance of new generation antivenoms, the author recommends systematically administer antivenom as early as possible to avoid unfavorable clinical progression, particularly in children and pregnant women..

Clinical Features, Management and Outcome of Snake Bite in Children in Manipal Teaching Hospital

Background: Snake bite is a widely distributed and neglected condition with a significant mortality. Medically significant snakes are: Elapidae, which are mainly neurotoxic and Viperidae, which are hemotoxic. Most studies on snake bites are done in Terai belt of Nepal and this is a first study of its kind in children in western region of Nepal. Methods: This was a 7 year retrospective study in Pediatric unit of Manipal Teaching Hospital, Pokhara, Nepal. Relevant data from all cases of snake bite in children up to 18 years of age was collected in a structured proforma and analyzed. Results: Among the 39 cases of Snake bites; it was more in boys (M: F=1.16:1), from rural areas (62%) and was more common during monsoon (64%). The commonest site of bite was foot (64%). Snakes were identifiable in only 23% of the cases. Local swelling (77%) and pain (74%) were common clinical features. Coagulation profile was deranged in 80% of the patients, hematuria was observed in 13% patients and 15% patients had thrombocytopenia. Most of the snakes were hemotoxic (77%) and only 1 case (2.5%) was neurotoxic. Only 44% of the patients received polyvalent anti-snake venom and blood products were required in 51% of the patients. Most patients improved (75%) and the case fatality rate was 2.5%. Conclusion: Most snakes found in mountainous region of Nepal are hemotoxic and lead to deranged coagulation profile. Mortality is low in hemotoxic as compared to neurotoxic envenomations. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 119-124 DOI: http://dx.doi.org/10.3126/njms.v2i2.8954

Snake bites in children at the Fez University Hospital in Morocco

The objective of our study is to describe the epidemiological, clinical, biological, and therapeutic aspects of snake bites in children in northern Morocco. This retrospective study reviewed files of all children admitted to the pediatric intensive care unit of the Hasssan II University Hospital in Fez from April 2011 through April 2013. It includes all children reported by themselves or their family to have been bitten by a snake and all those with traces of snake fangs. This study included 12 children, with a mean age of 9.6 ± 2.9 years. In each case, admission took place the day the envenomation occurred, a mean of 8.8 ± 5.6 hours after the bite. Locoregional signs and edema were seen in all cases, associated with bruising (58%) and blisters (25%). General events, including gastrointestinal, cardiovascular, neurologic, and hemorrhagic signs, affected 83% of the children. Hemostasis disorders occurred in 91% of patients, including profound thrombocytopenia (mean: 27.7 ± 30.7 G/L. All envenomations were grade 2 or grade 3. Analgesia was administered systematically; a fasciotomy was performed in 25% of cases and transfusion of blood products in 66%. Three children (25%) were intubated and two children died (16%). This series is characterized by the severity of the clinical presentations, with a predominance of locoregional complications and hemostasis disorders corresponding to snake-bite syndrome. We conclude that immunotherapy adapted to the local species must be made available to improve the prognosis of this envenomation.

Childhood tetanus from snakebite in Warri: a ten-year retrospective review

Background : Childhood tetanus from snakebite is a rare occurrence in Nigeria. It occurs more in adolescents and adults males. Aim : We report cases of tetanus in children following snakebite in Warri. Methods : Case notes of the children with tetanus from January 2000 to December 2009 at GN Chidren’s Clinic and Central Hospital Warri were used. Results : Only three cases were documented in 10 years and are presented below. Conclusion : Though tetanus from snakebites in children may be rare in our environment, there should be intensified efforts in eradicating the potentially fatal disease. Key words : Tetanus, children, snakebites, Warri, Nigeria

Factors affecting outcome in children with snake envenomation: a prospective observational study

ObjectivesTo evaluate clinical outcome and factors affecting outcome in children with snake envenomation.DesignProspective observational study.SettingPaediatric intensive care unit of a tertiary care teaching hospital in India.PatientsWe prospectively enrolled children ≤12...

Presentation and outcome of snake bite among children in Sokoto, North-Western Nigeria

Background: Snake bite with envenomation is a medical emergency. Children are at risk of severe manifestations due to small body mass. Unlike adult population, there is limited data on snake bite among children in Sokoto, North-Western Nigeria. We described the presentation and outcome of snake bite in children presenting to the Emergency Pediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: Case records of all children managed for snake bites from 1 st January 2003 to 31 st December 2012 were retrospectively reviewed. Demographic and other relevant information were retrieved and data analyzed using Microsoft Excel. Results: Out of 23,570 Pediatric admissions, 36 children had snake bites giving prevalence of 0.0015 (1.5/1000). Male: Female ratio was 1.6:1, with a mean (standard deviation) age of 9.6 ± 2.8 years (range = 1-14 years). Snakebites involved the lower limbs in 52.8%; and at home in 69.4%, and during the night in 58.3% of patients. The highest prevalence of bite was between April and July. Features of envenomation included local swelling (100%), prolonged clotting time (61.1%) and spontaneous hemorrhage (epistaxis and hematemesis) in 11.1%. One patient (2.8%) had seizure which may be incidental, though common causes such as hypoglycemia, malaria and meningitis were excluded by laboratory investigations. Polyvalent anti-snake venom was administered in 29 (80.6%) children, with adverse reaction observed in 13.8% (4/29) of the patients. Thirteen patients (36.1%) signed against medical advice while the remaining 23 (63.9%) were discharged home. Conclusion: Snake envenomation is associated with low morbidity and mortality in our study. Measures aimed at eliminating snake habitats around residential areas should be encouraged.

234. Severity of Snakebites in Children in the United States: 2000-2009

234. Severity of Snakebites in Children in the United States: 2000-2009