The decrease in samples classified as pathologic was most pronounced for blood count analytes except red cell distribution width and less pronounced for most biochemical analytes. Delayed puberty should be considered if females have not reached Tanner 2 thelarche by age 13 years old, or if males have not reached Tanner 2 gonadarche by age 14 years. The continuous reference intervals provided can therefore serve as an incentive for laboratory software manufacturers to implement new strategies for result display. Separation into overlapping age groups resulted in 38 — groups Table 1. The stability of each analyte over time during the study period is demonstrated by stable monthly median values see online Supplemental Tables 3 and 4.
We report continuous reference intervals for 22 important hematologic and biochemical analytes from birth to adulthood. We applied an indirect method for reference interval determination— an expanded version of an algorithm developed by Arzideh and colleagues 19 —21 —to each age group. The algorithm we used does not assume a normal gaussian distribution of healthy samples but a Box—Cox distribution, which is not symmetrical and is often used in statistics to represent skewed data Second, the shifts in classification are more distinct in analytes exhibiting pronounced variation with age e. For all three sites of development, Tanner Stage 1 corresponds to the pre-pubertal form with progression to Tanner Stage 5, the final adult form. Data tables containing age-specific upper and lower reference limits to enable integration of the calculated reference intervals into laboratory information systems are available in the online Supplemental Database. We compared classification with the current categorization method using conventional reference intervals from published literature or the manufacturer to categorization performed with the newly established continuous reference intervals. Introduction Puberty is a time of rapid and complex changes involving overlapping components: The first hormonal change in puberty is the pulsatile release of GnRH triggered by disinhibition of the hypothalamic-pituitary-gonadal HPG axis. Although the technical basis exists for such representations, they are rarely incorporated into current clinical practice. No hair Stage 3: The endocrine basis of puberty. Method details are available in online Supplemental Table 1, and precision data are presented in online Supplemental Table 2. Although adrenal maturation often coincides with HPG axis maturation, it is important to note that these processes occur independently of each other and that pubarche itself is not the best indicator of pubertal development. We split the samples in overlapping age groups to achieve a sample count of — per group, depending on the analyte Table 1 We included samples from 32 different inpatients and outpatients samples per analyte from a German pediatric tertiary care center. This is possible because the analysis of a comprehensive clinical laboratory database with an indirect approach has made a large number of measurements available for evaluation. Mickey Emmanuel1; Brooke R. Normal ages of pubertal events among American males and females. The continuous dynamics for many of the examined analytes are acknowledged and carefully considered in the selection of age partitions. Such an approach is restricted by the requirement of a large number of samples from healthy children 9. Plasma electrolytes and total protein concentration like- wise exhibited age-specific changes in concentration but no substantial sex-specific differences. Breast tissue palpable outside areola; no areolar development Stage 4: Terminal hair that extends beyond the inguinal crease onto the thigh Female Breast Development Scale Stage 1: This will enable us to meet the particular challenges in the establishment of pediatric reference intervals, which are limiting the interpretation of laboratory test results in children and adolescents. The reported values are directly applicable only for this population and these analytical platforms, in which case the data tables published online enable integration into laboratory information systems to allow automatic classification of test results see online Supplemental Database.
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