Clinical Profile and Outcomes of Pediatric Snakebite Envenomation: A Three-Year Retrospective Study From a Rural Tertiary Care Center in South India

Abstract

Background Snakebite envenomation remains a significant public health challenge in tropical countries, particularly affecting the pediatric population. Children are especially vulnerable because of their smaller body mass, outdoor activities, and delayed presentation to healthcare facilities. This study aimed to analyze the clinical profile, demographic patterns, and envenomation characteristics of snakebites in children aged 1-16 years presenting to a tertiary care center. Additionally, the study sought to evaluate the spectrum of complications and clinical outcomes in pediatric snakebite cases while assessing the mortality rate and associated risk factors in pediatric snakebite envenomation. Methodology A retrospective medical record review was conducted analyzing all snakebite cases in children aged below 16 years admitted to the Department of Pediatrics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu (southern state in India), between January 2021 and December 2023. Data extracted included demographics, bite characteristics, clinical manifestations, time to healthcare presentation, and treatment details. Management protocols followed World Health Organization (WHO) guidelines for snakebite envenomation, including the administration of polyvalent anti-snake venom (ASV) when indicated. Results Among 202 pediatric snakebite cases, children aged 9-12 years constituted the majority (n = 110, 54.5%), with significant male predominance (n = 148, 73.3%). Unidentified snakes were responsible for the highest proportion of bites (n = 72, 35.6%), followed by vipers (n = 65, 32.2%) and cobras (n = 53, 26.2%). Lower limb bites were most frequent (n = 108, 53.5%), and seasonal analysis revealed peak incidence during January-April (n = 106, 52.5%). Common clinical manifestations included hematuria (n = 112, 55.4%), oliguria (n = 102, 50.5%), and renal failure (n = 80, 39.6%). Most patients (n = 120, 59.4%) received antivenom within six hours, with 46.6% (n = 94) requiring 5-10 vials. The overall mortality rate was 9.9% (n = 20). Statistical analysis revealed significant associations between mortality and snake species identification (p = 0.0014), with the highest mortality in unidentified snakebites (n = 15, 20.8%). Anatomical bite site (p = 0.042), renal failure (p = 0.001), respiratory paralysis (p = 0.001), and ptosis (p = 0.001) were also significantly associated with mortality. Time to antivenom administration significantly impacted survival (p = 0.001), with mortality rates of 0.8% (n = 1) for treatment within six hours, increasing to 38.5% (n = 10) for delays beyond 12 hours. Demographics and local manifestations showed no significant correlation with mortality. Conclusion Our study reveals distinct patterns in pediatric snakebites, predominantly affecting male children in pre-adolescent age. The high proportion of unidentified snakes remains challenging. With renal and hematological manifestations being frequent, mortality is significantly influenced by delayed treatment, respiratory paralysis, and renal failure. Early antivenom administration, proper snake identification, and prompt medical intervention remain crucial factors in improving outcomes and reducing mortality.

Keywords: anti-snake venom; neuroparalytic; outcome assessment; snakebite; snakebite envenoming; vasculotoxic.

Figure 1. Clinical outcomes of pediatric snakebite cases (N = 202)