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Development of paediatric biochemistry centile charts as a complement to laboratory reference intervals

Loh, Tze Ping1; Antoniou, Georgia2; Baghurst, Peter2,3; Metz, Michael P.4

doi: 10.1097/PAT.0000000000000118
Chemical Pathology

Summary: Age-specific paediatric reference intervals are used in interpretation of laboratory results. However, interpretation may be problematic when a child just crosses an age bracket and the difference between the original and the subsequent age-specific reference interval is large. Moreover, details about the physiological changes with age may be masked.

For the 12 months ending 30 September 2013, results of 16 common clinical biochemistry tests of ambulatory paediatric patients aged 0–19, requested by primary care physicians, were retrospectively collected in a large pathology service, and used to construct smoothed centile charts using a penalised maximum likelihood method.

From the developed centile charts, the concentrations of sodium, bicarbonate, creatinine, urate, total protein, and albumin all increased with increasing age of the children. In contrast, the concentrations of potassium, chloride, anion gap, calcium, phosphate and lactate dehydrogenase decreased with increasing age of the children. Changes in the concentrations of urea, alkaline phosphatase, glucose, and total cholesterol varied by age. Generally, the boys and girls shared similar trend patterns until 10–15 years of age, when variations in the age of onset of puberty and development caused the trends of some biochemical measures to differ.

The paediatric biochemistry centile charts are intuitive tools to use. They complement age-specific reference intervals in the tracking, interpretation and discussion of laboratory results. They also enhance the understanding of underlying physiological changes in biochemistry in children.

1Department of Laboratory Medicine, National University Hospital, Singapore

2Public Health Research Unit, Women's and Children's Hospital, North Adelaide

3Disciplines of Paediatrics and Public Health, University of Adelaide

4Division of Laboratory Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia

Address for correspondence: Dr M. P. Metz, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5008, Australia. E-mail:

Received 25 March, 2013

Revised 28 October, 2013

Accepted 4 December, 2013

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© 2014 Royal College of Pathologists of Australasia
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