Cardiac Markers in Pediatric Laboratory Medicine: Critical Review

Area of Science:

• Pediatric Laboratory Medicine
• Clinical Biochemistry
• Cardiology

Background:

• Current interpretation of cardiac biomarkers in pediatrics lacks validated guidelines.
• Common biomarkers like cardiac troponins and natriuretic peptides have restricted clinical value due to age and sex variability.
• Standardized cut-off values for pediatric populations are absent.

Purpose of the Study:

• To summarize the analytical and clinical limitations of cardiac troponins and natriuretic peptides in neonates, children, and adolescents.
• To highlight the need for evidence-based interpretation standards in pediatric cardiac biomarker testing.

Main Methods:

• Literature review of published studies on pediatric cardiac biomarkers.
• Analysis of heterogeneity in subject, assay, and experimental protocol characteristics across studies.
• Synthesis of current data on cardiac troponins and natriuretic peptides in pediatric populations.

Main Results:

• Significant heterogeneity exists in studies evaluating pediatric cardiac biomarker reference values.
• Variability in subject characteristics (age, sex, pubertal status), assay types, and study protocols hinders result comparison.
• Existing data is insufficient for standardized interpretation of cardiac biomarkers in children.

Conclusions:

• Validated guidelines and standardized cut-offs are urgently needed for pediatric cardiac biomarker interpretation.
• Future research should focus on establishing evidence-based reference values for specific pediatric indications.
• Optimizing the utilization and interpretation of cardiac biomarkers in neonates, children, and adolescents requires further investigation.