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Overview

Pediatrics focuses on the physical/mental development, health care and disease prevention in children. Due to vast differences in age, physical body and gender among children, the determination of health status in child patients should not be measured by a single standard. Child patients may be allocated to infectious diseases and emergency medicine, and this must not be mixed or confused with those of internal medicine.

1. Risk

Child patients vary in age and development. As such, their non-specific immunity, humoral immunity and cellular immune function are not fully mature when compared to adults. For example, the levels of sIgA and IgG are much lower in infants and young children. Therefore, they are more prone to diseases such as respiratory and digestive infections. Healthcare officials must keep an eye out for such diseases and any relevant signs and symptoms.

2.Clinical Manifestations

Most of the clinical manifestations are based on children of a young age due to poor response to a disease. Manifestations include hypothermia, apathy, poor appetite, lack of crying with no obvious localized symptoms and signs. Due to their undeveloped immune system, infections may spread more rapidly and even progress into sepsis. Therefore, pediatric staff must closely observe and pay attention to any slight changes in the child’s condition.

Investigations and diagnosis

ReLIA’s Biomarker Guide

1. Procalcitonin (PCT)

   Infectious diseases make up a large portion of admissions in pediatrics. Systemic inflammatory response syndrome (SIRS) caused by infection is a fundamental pathophysiological change towards sepsis, and must be detected early. However, due to its complexity there is no ideal diagnosis, classification, prognosis and method to monitor treatment. Procalcitonin has a good correlation with the presence of infection and sepsis. After 20 years of research and practice it has been recommended as to help in the diagnosis, classification and prognosis of sepsis from bacterial infection.

2.Hypersensitive Troponin I (hs-cTnl)

    Hs-cTnI is a sensitive and practical biochemical indicator reflecting myocardial injury. It is the best clinical sensitivity and specificity of myocardial markers and can be used as an independent diagnostic indicator for myocardial infarction. The advent of the highly sensitive hypersensitive troponin I has made it impossible for small myocardial damage to escape its detection.

3.N terminal pro-brain natriuretic peptide (NT-proBNP)

   Compared to BNP, NT-proBNP has a longer half life (1-2 hours compared to BNP’s 20 minutes), a higher concentration in blood (15-20 times that of BNP) and is also biologically inactive. It also wont be affected by BNP related drugs. Therefore, NT-proBNP is recognized as a good biochemical marker that reflects cardiac function. It can be used to diagnose symptomatic heart failure, estimate the prognosis of patients with heart failure and acute coronary syndrome and to monitor treatment.

4.Creatine Kinase isoenzyme (CK-MB)

    CK-MB has long been regarded as one of the most specific enzyme biomarkers in the diagnosis of myocardial injury. However, the immunosuppression method of detection is hindered by interference factors, which affects its specificity. It is currently recommended by the American Heart Association and the European Society of Cardiology that the quality of CK-MB can instead be more accurately determined by the chemiluminesence method, which is more sensitive and specific.

5.CRP reactive protein (CRP)

   The incidence of neonatal infection is generally atypical, and due to atypical signs and symptoms, the mortality rate of infection is relatively high (40%). In the diagnosis of neonatal infection, C-reactive protein remains as the main marker for the diagnosis of bacterial infection, and has been widely used in pediatric clinical practice.