Biomarkers in neonatology

Abstract

The rapid increase in knowledge on basic biological research together with the development of high-technology diagnostic systems significantly contributes to gains expectancy in neonatal life. However, new efforts should be done in reducing time for translational research. The outcome of critically ill newborns such as septic newborns or newborns with acute kidney injury may be substantially improved by the routine use of novel biomarkers; they should demonstrate a rapid sustained increase to allow early detection of the acute disease within the critical time window. Additional critical factors should be the amount of release proportional to disease extent and the speed of assay. Three main factors must be carefully taken into account before addressing clinical significance to a biomarker: (a) the aim to be achieved by using a biomarker in clinical practice, (b) the nature of the disease or disorder, and (c) the population. No hypothesis about the effectiveness of a test can be formulated without knowing its purpose or objective since purpose is inherent in the formal definition of the effectiveness of a healthcare intervention. There is the need to introduce a new generation of biomarkers in clinical practice also for developing and commercializing new low-cost medical devices, easily usable in low-income countries. Proteomic approaches move a step beyond genomic studies and screen the actual proteins and peptides present in a sample. Metabolomics has several strengths compared with other "omics"; one of the most important strengths is that data acquisition does not require a priori knowledge on metabolites involved in any pathological condition: thus, data analysis may lead to the discovery of markers that were not previously considered. In the near future, advances in knowledge and technologies will lead to a revolution in healthcare, integrating several sets of data in a single patient related with the severity and the prognosis of diseases. In this scenario, characterized by the clinical application of system biology, proteomics and metabolomics will play a major role, improving neonatal care and survival of critically ill babies.