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Application of adult reference intervals in children

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Abstract

The aim of this study was to evaluate to which extend adult reference intervals (RIs) could be applied in children. A local paediatric population (aged 1 to < 20 years), based on first draw samples from general practitioners (GPs), was established. Children with samples taken at a hospital or > 3 samples from GPs were excluded. Analytes evaluated included haematological, liver and pancreatic function, kidney function, electrolytes, and metabolism parameters. Applicability of adult RIs in children aged 1–17 years was evaluated using individuals aged 18–19 years as reference groups for the adult RIs. The local population consisted of 31,024 children with 282,721 analyses in total. For each analyte, 17 age strata and two gender strata were established. Partitioning was not warranted in 51% of the male strata and in 69% of the female strata. Adult RIs could be applied in 42% for children aged 1–< 10 years, 57% for children aged 10–< 15 years, and 85% for children aged 15–<18 years.

Conclusion: for certain analytes, there is no need to partition between adult and paediatric RIs, but a need for age- and gender-specific RIs remains for several clinical laboratory tests.

What is Known:

• Establishing paediatric reference intervals (RIs) is time consuming, costly, and not feasible for many laboratories. Transference of RIs established elsewhere often leads to misclassification of paediatric laboratory results.

• Adult RIs are often more easily established and validated.

What is New:

• Adult RIs can be applied to children as young as 2 years for some analytes. Conversely, for some analytes, adult RIs cannot be applied in children aged 1–17 years.

• Laboratory data can be applied in evaluating the need for partitioning in reference intervals.

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Abbreviations

Alb:

Albumin

ALP:

Alkaline phosphatase

ALT:

Alanine transaminase

AMY:

Amylase

AMYP:

Amylase, pancreatic

AST:

Aspartate transaminase

Bil, conj:

Bilirubin, conjugated

BUN:

Blood urea nitrogen

Ca:

Calcium

CHOL:

Cholesterol

CK:

Creatine kinase

CLSI:

Clinical and Laboratory Standards Institute

Cr:

Creatinine

Erc:

Erythrocytes

EVF:

Erythrocyte volume fraction

F:

Female

Fe:

Iron

Glu:

Glucose

GGT:

γ-Glutamyl transferase

GP:

General practitioner

HDL:

High-density lipoprotein

Hgb:

Haemoglobin

K:

Potassium

LDH:

Lactate dehydrogenase

LDL:

Low-density lipoprotein

LH:

Lillebaelt Hospital

Lkc:

Leukocytes

M:

Male

MCH:

Mean corpuscular haemoglobin

MCHC:

Mean corpuscular haemoglobin concentration

MCV:

Mean corpuscular volume

Mg:

Magnesium

Na:

Sodium

OUH:

Odense University Hospital

P:

Phosphate

PLT:

Platelets

RI:

Reference interval

SI:

System of units

SD:

Standard deviation

TGL:

Triglyceride

TP:

Total protein

UA:

Uric acid

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Author notes

  1. Anne Bryde Alnor and Pernille Just Vinholt contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, Kolding, Denmark

    Anne Bryde Alnor

  2. Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark

    Pernille Just Vinholt

Authors
  1. Anne Bryde Alnor
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  2. Pernille Just Vinholt
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Contributions

Anne Bryde Alnor and Pernille Just Vinholt contributed equally to the present study.

The authors contributed equally to the present study.

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Correspondence to Anne Bryde Alnor.

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Alnor, A.B., Vinholt, P.J. Application of adult reference intervals in children. Eur J Pediatr 179, 483–491 (2020). https://doi.org/10.1007/s00431-019-03527-0

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