Pediatric Emergency and Intensive Care Units, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Pediatrics, Government Medical College Hospital, Sector 32, Chandigarh, India.
J Trop Pediatr. 2020 Aug 1;66(4):435-440. doi: 10.1093/tropej/fmz084.
Snake envenomation has been poorly studied in developing countries. 'Early morning neuroparalytic syndrome' (EMNS), the classical clinical constellation caused by krait bites, refers to nighttime, indoor bites where nonspecific symptoms progress to neuroparalysis. Literature regarding EMNS in children is scarce. This study was planned to describe the clinical profile, intensive care needs and predictors of outcome in children with EMNS.
It is a retrospective study of children below 12 years admitted with a clinical diagnosis of snake envenomation to the pediatric intensive care unit (PICU) of a tertiary care hospital in North India. Patient records were reviewed from the electronic patient database manager. Comparison was made between the EMNS group and the non-EMNS group and between survivors and nonsurvivors within the EMNS group.
Of the 111 children with snake envenomation, 76 had neuroparalysis (68%) and 51 had EMNS. In the EMNS cohort, 37 (72.5%) belonged to rural areas, 46 (90.2%) had indoor bites and 39 (76.5%) were witnessed. Patients with EMNS were more likely to have absent fang marks, hypoxemia at admission, bulbar palsy and need for PICU admission. Mortality rate was 13.7% in EMNS; predictors included younger age, presence of ptosis, cardiac arrest at admission and nonavailability of PICU bed (univariable analysis) but none of them independently predicted mortality.
Younger age, presence of ptosis, cardiac arrest at admission and nonavailability of intensive care beds increase the risk of mortality in children with EMNS. Timely recognition and respiratory support may reduce mortality in these children.
在发展中国家，对蛇咬伤的研究还很不完善。“清晨神经麻痹综合征”（EMNS）是由眼镜蛇咬伤引起的经典临床综合征，是指夜间、室内咬伤，其非特异性症状进展为神经麻痹。关于儿童 EMNS 的文献很少。本研究旨在描述儿童 EMNS 的临床特征、重症监护需求和预后预测因素。
这是一项在印度北部一家三级医院儿科重症监护病房（PICU）接受蛇咬伤临床诊断的 12 岁以下儿童的回顾性研究。从电子病历数据库中回顾患者记录。对 EMNS 组与非 EMNS 组、EMNS 组幸存者与非幸存者进行比较。
在 111 名蛇咬伤患儿中，76 例出现神经麻痹（68%），51 例出现 EMNS。在 EMNS 组中，37 例（72.5%）来自农村地区，46 例（90.2%）为室内咬伤，39 例（76.5%）有目击者。出现 EMNS 的患者更有可能出现无牙痕、入院时低氧血症、延髓麻痹和需要入住 PICU。EMNS 组的死亡率为 13.7%；预测因素包括年龄较小、上睑下垂、入院时心脏骤停和 PICU 床位不足（单变量分析），但均不能独立预测死亡率。
在儿童 EMNS 中，年龄较小、上睑下垂、入院时心脏骤停和重症监护病床不足会增加死亡率。及时识别和呼吸支持可能会降低这些儿童的死亡率。
