Background: Snake envenomation in children is a neglected tropical condition with high morbidity and mortality. Life threatening neurotoxic and hemotoxic envenomation in children demands timely Anti Snake Venom (ASV) administration to improve the outcome.Methods: This was a prospective observational study undertaken at the pediatric intensive care unit of tertiary care referral center at Chengalpattu. All the 26 children with evidence of snake envenomation were recruited after informed consent of the caregivers during the study period. Clinical presentation and ASV related reactions were studied.Results: In this study of 26 children with envenomation, neurotoxic envenomation was more common. Foot was the common bite site. 10 of the 18 children (55.5%) had nocturnal bites. Ptosis, local swelling, hypotonia, headlag, vomiting and shock were the common clinical features. Polyvalent antivenom was used in all these children. ASV reactions of varying severity was encountered in 18 of the 26 children (69.2%). All the acute ASV reactions were encountered in the first 30 minutes. All the 18 children had rashes to begin with. Rashes and itching were the common feature of ASV reactions. Among children with reactions shock was seen in 50 %. Overall mortality was 3.85% (one child). None died due to anaphylaxis. The administration of ASV in primary and secondary centers was not carried out in time and the occurrence of anaphylaxis were not managed with inj adrenaline prior to referral. Inj pheniramine maleate, atropine and hydrocortisone were used by those centers. Referral after ASV reactions led to delay in completion of ASV administration.Conclusions: Occurence of ASV reactions is high in children (69%). There is an undue delay in ASV completion with ASV reactions. There is an urgent need for prevention of ASV reactions either by monovalent venoms or premedication prior to ASV administration.

Background and Objectives To determine whether vestibular stimulation offered by Indian hammock and music intervention are useful in reducing the occurrence of infantile colic in term infants. Methods This open-labelled randomized clinical trial was conducted among 465 term neonates who were randomly assigned to one of three groups: music group, hammock group and control group. The music intervention was given for a cumulative duration of at least 4 h a day with one stretch of at least 1 h. In the hammock group, babies were put to sleep inside the Indian hammock and were swung gently until they sleep, and were allowed to sleep in it, until they wake up. For the control group, routine pre-discharge counselling was given. All parents were provided a cry log and were instructed to record the log of cry events and duration. The primary outcome measure was occurrence of infantile colic episode as defined by ROME IV criteria. The infants were followed up from birth until the age of 3.5 months, and the cry log was collected during each follow-up visit. Results Of the 435 term neonates who completed follow-up, 59 infants developed infantile colic (13.6%). The prevalence of infantile colic in the control group, music group and the Indian hammock group was 25.6%, 5.4% and 9.6% respectively; there was a significant reduction in the prevalence of infantile colic in the intervention groups as compared to the control group. Conclusions Vestibular stimulation by Indian hammock and music intervention individually reduced the occurrence of infantile colic.