Advances in biomarkers for predicting outcomes in pediatric neurosurgical hemorrhagic conditions: a narrative review to enhance quality of care

Pediatric neurosurgical hemorrhagic conditions, such as subarachnoid hemorrhage, intracerebral hemorrhage, and arteriovenous malformations, present unique diagnostic and therapeutic challenges. Advances in biomarker research offer promising opportunities to enhance diagnostic precision, outcome prediction, and personalized therapeutic strategies. This narrative review aims to synthesize current evidence on the role of biomarkers in pediatric neurosurgical hemorrhagic conditions and highlight their integration into clinical practice to improve outcomes. This narrative review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to ensure transparency and reproducibility. A comprehensive literature search was performed across PubMed and EMBASE for studies published between January 2000 and February 2024, with earlier landmark studies included for context. English-language articles were screened based on relevance, with two reviewers independently selecting studies on biomarkers in pediatric hemorrhagic neurosurgical conditions. Studies with no relevant biomarker information, non-english articles, and case-reports were excluded. Data were extracted on biomarker types, functions, detection methods, and clinical outcomes. Thematic analysis was used to synthesize findings, and the quality of included systematic reviews was assessed using AMSTAR 2. Biomarkers like S100B and neuron-specific enolase aid in prognostication and therapeutic guidance, especially when combined with imaging modalities. Challenges in lack of standardized protocols, high costs, and limited pediatric-specific research persist. Global collaboration and innovative approaches are critical to address these barriers and optimize biomarker utility in clinical settings. Biomarkers represent a transformative approach in pediatric neurosurgery, enhancing diagnostic accuracy and treatment personalization. Future efforts should focus on validating pediatric-specific biomarkers, addressing disparities in health care access (or overcoming barriers to implementation), and fostering global collaboration to standardize biomarker use.