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High-resolution pediatric reference intervals for 15 biochemical analytes described using fractional polynomials

Jakob Zierk1,2, Hannsjörg Baum3, Alexander Bertram4

  • 1Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.

Clinical Chemistry and Laboratory Medicine
|February 10, 2021
PubMed

Insights

New pediatric reference intervals and charts are available for assessing children's lab results. These data-driven tools account for age and sex dynamics, improving clinical decision-making for neonates and older children.

Area of Science:

  • Clinical Chemistry
  • Pediatric Laboratory Medicine
  • Biochemical Analysis

Background:

  • Pediatric reference intervals are crucial for accurate interpretation of laboratory test results in children.
  • Physiological development causes significant age- and sex-specific changes in biochemical analytes.
  • Existing pediatric reference intervals are limited, especially for comprehensive coverage from birth to adulthood.

Purpose of the Study:

  • To establish data-driven, continuous pediatric reference intervals covering birth to adulthood.
  • To develop percentile charts and mathematical functions for integrating into laboratory information systems.
  • To address the limitations of current pediatric reference intervals.

Main Methods:

  • Utilized a large dataset from 13 German centers, encompassing over 10 million laboratory test results from 638,683 patients.
  • Employed a validated statistical approach (kosmic) to estimate physiological test result distributions.
  • Excluded repeat measurements from individual children to ensure data integrity.

Main Results:

  • Generated continuous pediatric reference intervals and percentile charts for 15 key biochemical analytes.
  • Provided reference intervals as tables and fractional polynomial functions for easy integration into lab systems.
  • Developed Z-scores and percentiles for normalizing test results by age and sex.

Conclusions:

  • The new reference intervals and charts allow for precise assessment of pediatric laboratory tests.
  • Highlighted the significant analyte dynamics in neonates, emphasizing the need for tailored reference intervals.
  • These tools enhance clinical decision-making by providing accurate, age- and sex-specific interpretations.
Abstract

Keywords:
continuous reference intervalsdata miningindirect reference intervalspediatric reference intervalspercentile charts

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