Establishing Pediatric Reference Intervals: A Challenging Task
2012; American Association for Clinical Chemistry; Volume: 58; Issue: 5 Linguagem: Inglês
10.1373/clinchem.2012.183483
ISSN1530-8561
Autores Tópico(s)Reliability and Agreement in Measurement
ResumoDefining pediatric reference intervals (RIs) is one of the most difficult tasks in our profession. The continuously changing physiology of growing children makes their laboratory values a moving target. For specific analyte measurement in pediatric age, one has to consider the interindividual variation not only of the homeostatic point, but also of the timing with which the development of the individual occurs. In this sense, the first year of life and puberty are the most critical periods. In addition, ethnic and behavioral differences may also cause variations. The only way to deal with such complexity is to gather large populations of reference individuals; however, the ethical problems involved in drawing blood from a healthy newborn or child further complicate this already demanding effort. Therefore, although one of the seminal reports on RIs was published in 1960 by pediatrician Albert John Schneider (1), it is not surprising that very few data on pediatric RIs exist. It is against this rather dark backdrop that the work of Colantonio and coworkers (2) described in this issue of the Journal sheds new light; however, a careful evaluation of this study is necessary to fully understand its relevance. Ceriotti et al. (3) have listed 4 criteria that must be considered in the appraisal of any RI study: ( a ) the selection of reference individuals; ( b ) the study design; ( c ) the analytical quality of the data; and ( d ) the statistical treatment of the data. The selection of reference individuals represents one of the major strengths of the study of Colantonio et al. These investigators applied an “a priori” selection scheme by enrolling volunteers or using leftover samples from well-characterized healthy newborns or from select outpatient clinics (for dentistry, bone fractures, plastic surgery). Such an approach is particularly relevant because, as indicated by the IFCC and by CLSI …
Referência(s)