Clinical and Laboratory Predictors of Mortality Following Snake Bite Envenomation in Children in Central India: A Retrospective Observational Study

Background: About half of global deaths following snake envenomation occur in India and proportionally highest mortality at ages 5-14 years. Very few studies have evaluated clinical and laboratory predictors of mortality in children. Abstract Keywords: Envenomation; Central India; Predictors; Snake Bite; Risk FactorsRESEARCH ARTICLE Volume 1 | Issue 2 ScholArena | www.scholarena.com Journal of Pediatric Disorders and Neonatal Care Open AccessIntroduction Objective: Evaluation of clinical and laboratory parameter associated with mortality of snake envenomation in children Design: Retrospective observational cohort study. Material and Methods: Medical record files of children of snake envenomation, between the periods of Jan 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 envenomation, laboratory investigation and outcome. Result: Of 46 children studied 37 (80.43%) were > 5 years and male to female ratio is 1.4:1. Lower limb was commonest site of bite in night time and mostly in monsoon. Local edema and vomiting was commonest presentation. Most 26(56.53%) had predominantly vasculotoxic envenomation while 14(30.43%) predominantly neurotoxic and 6(13.04%) mixed envenomation. 9 children died giving case fatality rate 19.56%. On univariate analyses following variables were found to be significantly associated mortality: age more than 5 years (p=0.03), diplopia (p=0.001), ptosis (p<0.001), altered consciousness (p<0.001), cellulitis (0.001), respiratory failure (p=0.001), hypotension (p=0.04) requiring inotropic support, and prolonged prothrombin time (p=0.02). None of the variables were significant on multivariate analysis.