Cardiac Biomarkers in Pediatrics

Bottom Line Up Front (BLUF):

• Compared to healthy adults, the serum troponin and BNP levels in healthy neonates, infant, and children have normal ranges with 90th and 99th percentiles up to two orders of magnitude greater.
• Though studies have begun to quantify the normal ranges in these pediatric populations, as of January 2022, no diagnostic cutoffs have been validated (or even proposed).
• Indeed, considering the markedly higher normal ranges, and as argued by Assandro et al in 2013, these cardiac biomarkers may lack the ability to distinguish disease from non-disease in some (or all) of these age groups.
• No one should order a cardiac biomarker in these age groups with the intent to rule-in or rule-out disease without:

1. Evidence that the marker can distinguish disease from non-disease (i.e. the associated AUROC) in the age group in question.
2. Knowing the diagnostic-cutoff for the disease in question, as well as the associated sensitivity and specificity.

• False-positive interpretation of cardiac biomarkers frequently leads to unnecessary invasive testing, which is itself a harm, but also carries a non-negligible risk of additional harm (i.e. procedural complications).

REFERENCES

Author[s]:

Andrew W. Swartz, MD

Reviewer[s]:

Leslie Herrmann, MD