title: Should blood gas analysis be part of the diagnostic workup of short children? Auxological data and blood gas analysis in children with renal tubular acidosis.
abstract: BACKGROUND
  Renal tubular acidosis (RTA) is a rare cause of growth failure, therefore it is uncertain whether routine screening with blood gas analysis of short infants and children is cost-effective.
  
  
  OBJECTIVE
  To investigate the clinical, growth and laboratory parameters in children with RTA to estimate the possible value of laboratory screening for this disorder in infants and children referred for short stature according to a recent guideline.
  
  
  METHODS
  Retrospective chart analysis of 30 children diagnosed between 1978 and 2005 in The Netherlands and 3 centers in Belgium.
  
  
  RESULTS
  The current guideline for short stature detected 33% of children with RTA. Assuming a pre-test probability of RTA of 0.6 per 100,000 births, the likelihood ratio of poor growth was 58 and 17 below and above 3 years, respectively. Sensitivity was 17/30 and 12/24 for a -2.0 SDS cutoff for weight and body mass index, respectively. In infants and toddlers diagnosed before 3 years of age, the mean weight loss was 1.5 SD, and 0.8 SDS in older children. In short children >3 years RTA was extremely rare, always associated with clinical symptoms, and rarely detected by blood gas analysis.
  
  
  CONCLUSIONS
  According to our data a decreasing weight SDS for age is a sufficient indication to perform blood gas analysis in children <3 years of age, particularly in the presence of additional clinical features, whereas it can be omitted in short children >3 years of age.
authors.affiliation: Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. d.mul@hagaziekenhuis.nl
authors.forename: D
authors.initials: D
authors.lastname: Mul
authors.forename: F K
authors.initials: FK
authors.lastname: Grote
authors.forename: J R
authors.initials: JR
authors.lastname: Goudriaan
authors.forename: S M P F
authors.initials: SM
authors.lastname: de Muinck Keizer-Schrama
authors.forename: J M
authors.initials: JM
authors.lastname: Wit
authors.forename: W
authors.initials: W
authors.lastname: Oostdijk
mesh_terms: D000141:Acidosis, Renal Tubular / Q000097:blood* / Q000150:complications; D001530:Belgium; D001784:Blood Gas Analysis; D001827:Body Height / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D005183:Failure to Thrive / Q000097:blood; D005260:Female; D006130:Growth Disorders / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D012015:Reference Standards; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology