Antivenom use and 24-hour hemostatic recovery after pediatric Malayan pit viper envenomation: a 10-year ED cohort in Vietnam

Objective To describe antivenom use and 24-hour clinical/hemostatic recovery after pediatric Malayan pit viper envenomation in southern Vietnam. Methods We retrospectively studied children aged 1 month–15 years treated during 2011–2020. Cases met direct or presumed species-identification criteria. Severity was recorded at ED arrival and at the treatment-decision assessment; severity-stratified antivenom analyses used the latter. Clinical findings were reassessed at baseline and 6, 12, 18, and 24 h. Serial laboratory analyses used time-specific available-case denominators. Results Fifty-four children were included; 46 (85.2%) received antivenom. Median door-to-antivenom time was 0.9 h (IQR 0.5–3.9), and bite-to-antivenom time was 12.3 h (IQR 7.6–26.1). No child received more than two administrations. At 24 h, bite-site bleeding was documented absent in 23/25 children (92.0%; 95% CI 75.0–97.8). Among patients with available 24-h laboratory measurements after an abnormal baseline value, INR ≤1.5 occurred in 17/18 (94.4%; 95% CI 74.2–99.0) and fibrinogen >1 g/L in 16/21 (76.2%; 95% CI 54.9–89.4). Acute reactions were mild and uncommon. Fifty-three children (98.1%) were discharged improved; one (1.9%) died. Conclusions Early clinical and laboratory improvement was observed during 24-hour monitoring after antivenom in this retrospective single-center pediatric referral cohort. Findings are descriptive and do not establish antivenom effectiveness or an optimal dosing strategy.