Venomous snakebites in children: a 10 year experience in South China

Abstract

Introduction

Many studies have focused on snakebites in adults, but very few have described snakebites in children.

Methods

We reviewed the clinical characteristics and outcomes of children with venomous snakebites aged less than 15 years who presented to a regional medical centre in South China from January 2013 to December 2022.

Results

A total of 69 envenomed patients were analyzed in our study; 42 (60.9 per cent) patients were male, and 59 (85.5 per cent) reported lower limb bites. Most bites (89.8 per cent) occurred between April and October. Twenty-seven patients received first aid management, and 47 required admission to the general ward. Antivenom was administered to 58 patients, glucocorticoids to 43 patients, antibiotics to 48 patients, and tetanus antitoxin to 40 patients. No fatalities were reported. The most common snake identified was Trimeresurus albolabris. Four were classified as dry bites, 15 as mild, 43 as moderate, and seven as severe. The most common local signs were pain and swelling, while the most common systemic effects were haematological complications. Patients with high severity scores had significantly higher lactate dehydrogenase activities, creatine kinase isoenzyme activities, aspartate aminotransferase activities, D-dimer concentrations, prothrombin times and lower fibrinogen concentrations. In a receiver operating characteristic curve analysis of the values with the highest Youden index, the following cut-offs proved significant: lactate dehydrogenase activity > 248.1 U/L, creatine kinase isoenzyme activities > 17.5 U/L, fibrinogen concentration < 1,455 mg/L, D-dimer concentration > 437.0 µg/L, aspartate aminotransferase activity > 26.1 U/L, and prothrombin time > 15.2 seconds.

Discussion

This study provides insight into the epidemiology, clinical profile, and management of snakebites in children. Data from the present study were compared with those from our previous adult study. Limitations include that 50.7 per cent of our snakebites were attributed to Trimeresurus albolabris. Therefore, the results of our study may not be generalizable to all snakebites.

Conclusion

The clinical symptoms were more severe in children than in adults in our previous study. Even though there were no fatalities, close monitoring should be performed to detect haematological and other potentially fatal complications promptly.

Keywords:

• Clinical characteristics
• children
• management
• prognosis
• venomous snakebite

Acknowledgments

We would like to thank reptile specialist Dr Shuo Qi at Sun Yat-Sen University (Guangzhou, South China) for helping us identify snake species.

Authors’ contributions

Conceptualization: Liangbo Zeng and Qianqin Li; Data acquisition: Yan Huang and Jiangfu Luo; Data curation: Liangbo Zeng and Youhong Zhang; Formal analysis: Qianqin Li; Investigation: Qianqin Li; Methodology: Qianqin Li; Resources: Liangbo Zeng and Qing Liang; Supervision: Liangbo Zeng and Qing Liang; Validation: Qianqin Li; Writing-original draft: Qianqin Li and Youhong Zhang; Writing-review and editing: Qianqin Li. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the research project for clinical application and transformation of the First Affiliated Hospital of Guangzhou Medical University (number ZH201815), the Guangzhou Science and Technology Program City and University (Hospital) joint funded grant (identification: 202102010282) and the general project grant of the Natural Science Foundation of the Guangdong Basic and Applied Basic Research Foundation (identification: 2022A1515012095).