Acute poisoning in young children: a 10-year analysis from Ramathibodi Poison Center

INTRODUCTION: Acute poisoning remains a significant cause of preventable pediatric morbidity worldwide. While epidemiological patterns in high-income countries are well-documented, data from low- and middle-income countries remain distinct. This study aims to identify the epidemiology, toxic agents, and risk factors associated with death in children aged less than six years in Thailand. METHODS: We conducted a retrospective cohort study utilizing the Ramathibodi Poison Center Toxic Exposure Surveillance System database from January 2011 to December 2020. Multinomial logistic regression was performed to identify independent associations with clinical severity and mortality. RESULTS: During the study period, 37,076 pediatric exposures were evaluated. The majority of exposures were unintentional (99.8%) and occurred via oral ingestion (94.7%). The most common exposure categories were general-purpose chemicals (45.8%), medications (27.5%), and pesticides (19.0%). Overall mortality was 0.3% (114 deaths). The leading causes of death were pesticides (bipyridyl), general-purpose chemicals (cyanide solution), and natural toxins (cobra venom). Regression analysis identified the newborn age group as a significant independent association of mortality (odds ratio 8.26, 95% CI 4.00-17.18) and major clinical effects (odds ratio 4.59, 95% CI 2.27-9.26). Exposure to natural toxins was strongly associated with worse outcomes (odds ratio 5.33, 95% CI 2.63-10.80) and major effects (odds ratio 15.46, 95% CI 9.04-26.44). DISCUSSION: Our finding differs from that in high-income countries. While pediatric poisoning in high-income countries is predominantly driven by pharmaceuticals, our study population was most frequently exposed to general-purpose chemicals and pesticides. Significantly, newborns were identified as the most vulnerable group for severe outcomes and death. CONCLUSIONS: Pediatric poisoning exposures in Thailand present unique regional challenges compared to high-income nations. Preventive strategies and clinical education in this region must prioritize the mitigation of highly lethal, non-pharmaceutical agents such as paraquat, hydrocarbons, and local venomous species.