Paediatric Snakebite Toxicity up to Compartment Syndrome: A Ten-Year Retrospective Study in Iasi, Romania.

A total of 24 paediatric viper bite cases were treated at Saint Mary Emergency Hospital in Iasi, Romania over a 10-year period (2016-2025).

• All patients were under 18 years of age.
• Cases were encountered in the emergency department of a single institution.
• The study design was observational and retrospective.
• The study period spanned 2016 to 2025.

The lower limb was the predominant bite location in paediatric viper bite cases.

• 83.33% of viper bites were located on the lower limb.
• This finding was identified across all 24 cases in the study cohort.

One case out of 24 evolved into compartment syndrome requiring fasciotomy.

• This case was described as 'rare and severe'.
• The patient required fasciotomy performed in the Plastic Surgical Department to save the limb.
• This represented the most serious surgical complication observed in the study cohort.
• The case was analysed in detail with available images and investigations to highlight pathophysiological and therapeutic aspects.

A second representative case involving an upper limb bite presented with perilesional oedema without severe local signs.

• The bite was localised at the upper limb.
• Clinical findings included perilesional oedema without skin colour changes or secretions.
• Preservation of joint contours and normal nail colouration were observed.
• This case was also analysed in detail alongside the compartment syndrome case.

Multidisciplinary treatment including antivenom administration and selective fasciotomy contributed to successful outcomes in paediatric viper bite cases.

• Antivenom administration was identified as a key therapeutic intervention.
• Selective fasciotomy was used in the case that evolved to compartment syndrome.
• Appropriate multidisciplinary treatment was reported to considerably improve functional prognosis.
• The study emphasised the need for prompt and multidisciplinary treatment.

Viper bites in children are identified as an ongoing public health problem in Romania.

• The study highlights that viper bites can develop into serious clinical complications that can endanger the life of paediatric patients.
• The cases were drawn from a 10-year period at a regional emergency hospital, suggesting continued occurrence.
• Specialised surgical monitoring was required in a subset of cases.
• The authors call for prompt and multidisciplinary treatment approaches.