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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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A Rapid and Chemical-free Hemoglobin Assay with Photothermal Angular Light Scattering
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Paediatric Reference Intervals and Curves for Haemoglobin Estimated Using Direct Methods: A Systematic Review and

Vid Bijelić1,2, Marijana Bijelić1, Josh Larock3

  • 1School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

International Journal of Laboratory Hematology
|May 3, 2025
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Summary

This study synthesized evidence on pediatric hemoglobin reference intervals (RIs) and reference curves (RCs), finding significant heterogeneity. More rigorous global estimates are needed to accurately define anemia in children, especially the youngest.

Keywords:
anaemiaepidemiologyhaemoglobinironreference curvesreference intervals

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Area of Science:

  • Clinical Chemistry
  • Pediatric Hematology
  • Public Health

Background:

  • Hemoglobin testing is crucial for assessing child health.
  • Laboratories use reference intervals (RIs) and reference curves (RCs) to interpret pediatric hemoglobin results.
  • Existing RIs/RCs show considerable variation, impacting anemia diagnosis.

Purpose of the Study:

  • To systematically review and synthesize evidence on pediatric hemoglobin RIs/RCs.
  • To investigate sources of heterogeneity in existing pediatric hemoglobin RIs/RCs.
  • To compare findings with World Health Organization (WHO) anemia thresholds.

Main Methods:

  • Systematic review of studies on pediatric hemoglobin RIs/RCs (PROSPERO: CRD42023399802).
  • Searched EMBASE, MEDLINE, SCOPUS, and Cochrane libraries up to July 31, 2023.
  • Included studies adhering to CLSI guidelines and reporting confidence intervals; excluded unhealthy children and cord-blood RIs.

Main Results:

  • Analyzed 48 studies (123,498 participants) from 25 countries.
  • Pooled estimates for 0-3 months not possible; for older children, RIs generally increased with age.
  • Significant heterogeneity found, with sources including age, sex, analyzer type, and country; many RIs differed from WHO thresholds.

Conclusions:

  • Substantial heterogeneity in pediatric hemoglobin RIs/RCs necessitates more robust global estimates.
  • Improved RIs/RCs are needed to align with WHO anemia thresholds for consistent diagnosis.
  • Further research on RIs for infants and the use of percentile curves is recommended.