Current and Future Indication for Testing and Use of Cardiac Troponin in Children
Kristin M Aakre1,2, Aamir Jeewa3, Louise Cullen4,5
1Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Clinical Chemistry
|March 27, 2026
Summary
Cardiac troponin (cTn) interpretation in children is inconsistent. Current data show high cTn levels in newborns, decreasing with age, with low myocardial injury incidence. More research is needed for pediatric cTn testing.
Area of Science:
- Pediatric Cardiology
- Clinical Chemistry
- Biomarker Research
Background:
- Clinical use and interpretation of cardiac troponins (cTn) in pediatric patients are highly variable.
- Existing literature and expert discussions highlight the need for standardized practices in pediatric cTn testing.
Purpose of the Study:
- To summarize current knowledge and best practices for cTn measurements in pediatric patients.
- To discuss appropriate upper reference limits, age- and sex-related concentration influences, and preanalytical/analytical considerations.
- To provide consensus on optimal interpretation of pediatric cTn results.
Main Methods:
- Literature appraisal and synthesis.
- Discussions among international committee members, pediatricians, cardiologists, emergency physicians, and laboratorians.
Main Results:
- Healthy infants and newborns exhibit high cTn concentrations, with levels decreasing until age 1-3 years and rising to adult levels by puberty.
- The incidence of myocardial injury is low and depends on the chosen upper reference limit (97.5th or 99th percentile).
- Primary indications for cTn testing include suspected myo/pericarditis or traumatic chest injury; testing for heart failure/ischemia is less common.
Conclusions:
- Current pediatric cTn data are limited, often retrospective, and largely based on expert opinion.
- Heterogeneity exists in published clinical studies regarding cTn interpretation.
- Further research is essential across all aspects of pediatric cTn testing to establish evidence-based guidelines.
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