title: Pediatric reference intervals for alkaline phosphatase.
abstract: BACKGROUND
  Interpretation of alkaline phosphatase activity in children is challenging due to extensive changes with growth and puberty leading to distinct sex- and age-specific dynamics. Continuous percentile charts from birth to adulthood allow accurate consideration of these dynamics and seem reasonable for an analyte as closely linked to growth as alkaline phosphatase. However, the ethical and practical challenges unique to pediatric reference intervals have restricted the creation of such percentile charts, resulting in limitations when clinical decisions are based on alkaline phosphatase activity.
  
  
  METHODS
  We applied an indirect method to generate percentile charts for alkaline phosphatase activity using clinical laboratory data collected during the clinical care of patients. A total of 361,405 samples from 124,440 patients from six German tertiary care centers and one German laboratory service provider measured between January 2004 and June 2015 were analyzed. Measurement of alkaline phosphatase activity was performed on Roche Cobas analyzers using the IFCC's photometric method.
  
  
  RESULTS
  We created percentile charts for alkaline phosphatase activity in girls and boys from birth to 18 years which can be used as reference intervals. Additionally, data tables of age- and sex-specific percentile values allow the incorporation of these results into laboratory information systems.
  
  
  CONCLUSIONS
  The percentile charts provided enable the appropriate differential diagnosis of changes in alkaline phosphatase activity due to disease and changes due to physiological development. After local validation, integration of the provided percentile charts into result reporting facilitates precise assessment of alkaline phosphatase dynamics in pediatrics.
authors: Jakob
authors: J
authors: Zierk
authors: Farhad
authors: F
authors: Arzideh
authors: Rainer
authors: R
authors: Haeckel
authors: Holger
authors: H
authors: Cario
authors: Michael C
authors: MC
authors: Frühwald
authors: Hans-Jürgen
authors: HJ
authors: Groß
authors: Thomas
authors: T
authors: Gscheidmeier
authors: Reinhard
authors: R
authors: Hoffmann
authors: Alexander
authors: A
authors: Krebs
authors: Ralf
authors: R
authors: Lichtinghagen
authors: Michael
authors: M
authors: Neumann
authors: Hans-Georg
authors: HG
authors: Ruf
authors: Udo
authors: U
authors: Steigerwald
authors: Thomas
authors: T
authors: Streichert
authors: Wolfgang
authors: W
authors: Rascher
authors: Markus
authors: M
authors: Metzler
authors: Manfred
authors: M
authors: Rauh
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000032:analysis* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics; D012016:Reference Values
chemical_list: D000469:Alkaline Phosphatase