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Serum biomarkers in severe paediatric traumatic brain injury-a narrative review
Anusha Ganeshalingham1, John Beca1
1Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
Insights
Biomarkers like S100B and NSE show promise in diagnosing severe traumatic brain injury (TBI) and predicting neurodevelopmental outcomes in children. These molecular signatures may help unify TBI heterogeneity for better management.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Biomarker Discovery
Background:
- Severe traumatic brain injury (TBI) in children presents significant management and prediction challenges.
- Heterogeneity in TBI pathology and severity complicates treatment efficacy and outcome prediction.
- Current multi-center trials of specific therapies have yielded disappointing results due to this heterogeneity.
Purpose of the Study:
- To explore the potential of biomarkers in diagnosing TBI severity and predicting neurodevelopmental outcomes in children.
- To investigate if biomarkers can help unify the heterogeneous nature of TBI.
- To assess the clinical utility of biomarkers for guiding interventions and planning rehabilitation.
Main Methods:
- Analysis of serum S100B and serum NSE levels in children with severe TBI.
- Comparison of biomarker levels between children with severe TBI and controls (implied).
- Evaluation of the correlation between biomarker levels and neurodevelopmental outcomes.
Main Results:
- Serum S100B and serum NSE levels were significantly elevated in children with severe TBI, including inflicted and non-inflicted head injuries.
- These biomarkers show promise as diagnostic tools for TBI severity.
- Serum S100B and NSE also demonstrated potential as predictors of neurodevelopmental outcomes.
Conclusions:
- Biomarkers offer a potential method to address the heterogeneity of TBI in children.
- Serum S100B and NSE are promising candidates for diagnosing TBI severity and predicting long-term outcomes.
- Further research and validation are needed, but biomarkers may soon be clinically applicable for TBI management.
Abstract:
Severe traumatic brain injury continues to present complex management and prediction challenges for the clinician. While there is some evidence that better systems of care can improve outcome, multiple multi-centre randomised controlled trials of specific therapies have consistently failed to show benefit. In addition, clinicians are challenged in attempting to accurately predict which children will recover well and which children will have severe and persisting neurocognitive deficits. Traumatic brain injury is vastly heterogeneous and so it is not surprising that one therapy or approach, when applied to a mixed cohort of children in a clinical trial setting, has yielded disappointing results. Children with severe traumatic brain injury have vastly different brain injury pathologies of widely varying severity, in any number of anatomical locations at what may be disparate stages of brain development. This heterogeneity may also explain why clinicians are unable to accurately predict outcome. Biomarkers are objective molecular signatures of injury that are released following traumatic brain injury and may represent a way of unifying the heterogeneity of traumatic brain injury into a single biosignature. Biomarkers hold promise to diagnose brain injury severity, guide intervention selection for clinical trials, or provide vital prognostic information so that early intervention and rehabilitation can be planned much earlier in the course of a child's recovery. Serum S100B and serum NSE levels show promise as a diagnostic tool with biomarker levels significantly higher in children with severe TBI including children with inflicted and non-inflicted head injury. Serum S100B and serum NSE also show promise as a predictor of neurodevelopmental outcome. The role of biomarkers in traumatic brain injury is an evolving field with the potential for clinical application within the next few years.
