reference range values for pediatric care
TRANSCRIPT
Reference RangeValuesfor Pediatric Care
Reference Reference Reference Reference RangeRangefor Pediatric Carefor Pediatric Carefor Pediatric CareLamia Soghier, MD, FAAPEditor
Katherine Pham, PharmD, BCPSSara Rooney, PharmD, BCPSContributing Editors
Reference Range Values for Pediatric CareLamia Soghier, MD, FAAPEditor
Contributing editorsKatherine Pham, PharmD, BCPSSara Rooney, PharmD, BCPS
Custom designed for today’s busy practitioners, this quick-access resource provides commonly used ranges and values spanning birth through adolescence. Data needed for management of preterm and other newborns is highlighted throughout.
Look here for practice-focused help with• Blood pressure ranges• Body surface area calculation• Bone age metrics• Hematology values • Cerebrospinal � uid values• Lymphocyte subset counts• Clinical chemistry ranges• Thyroid function• Endocrine values• Umbilical vein and artery
catheterization measurements• Caloric intake values
… and more!
Assessment and management tools you’ll use again and again
Save time and simplify clinical problem solving with a full set of easy-to-use tools from the AAP and other authoritative sources.
• Apgar and New Ballard newborn scoring
• Growth charts• Metric conversion tables• Pain scales• Blood pressure nomograms• Hyperbilirubinemia nomograms• Enteral formulas • GIR calculators • AAP immunization schedules • AAP periodicity schedule
For other pediatric resources, visit the AAP Bookstore at www.aap.org/bookstore.
Reference Range Values for Ped
iatric Care
AAP
IncludesFrench CatheterScale sample!
Reference RangeValuesfor Pediatric Care
Lamia Soghier, MD, FAAPEditor
Katherine Pham, PharmD, BCPS Sara Rooney, PharmD, BCPS
Contributing Editors
American Academy of Pediatric Department of Marketing and Publications Staff
Maureen DeRosa, MPA, Director, Department of Marketing and PublicationsMark Grimes, Director, Division of Product DevelopmentAlain Park, Senior Product Development EditorCarrie Peters, Editorial Assistant Sandi King, MS, Director, Division of Publishing and Production ServicesTheresa Wiener, Manager, Publications Production and ManufacturingAmanda Cozza, Editorial SpecialistPeg Mulcahy, Manager, Graphic Design and ProductionJulia Lee, Director, Division of Marketing and SalesLinda Smessaert, Brand Manager, Clinical and Professional Publications
Library of Congress Control Number: 2013949731ISBN: 978-1-58110-849-1eISBN: 978-1-58110-854-5MA0702
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Every effort has been made to ensure that the drug selection and dosage set forth in this text are in
accordance with the current recommendations and practice at the time of publication. It is the respon-
sibility of the health care professional to check the package insert of each drug for any change in indica-
tions and dosage and for added warnings and precautions.
The mention of product names in this publication is for informational purposes only and does not imply
endorsement by the American Academy of Pediatrics.
The publishers have made every effort to trace the copyright holder for borrowed material. If they
have inadvertently overlooked any, they will be pleased to make the necessary arrangement at the
first opportunity.
Copyright © 2014 American Academy of Pediatrics. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechani-
cal, photocopying, recording, or otherwise, without prior permission from the publisher.
Printed in the United States of America.
9-345/0314
1 2 3 4 5 6 7 8 9 10
iii
EditorLamia M. Soghier, MD, FAAPAssistant Professor of PediatricsThe George Washington University School of Medicine and Health SciencesMedical Unit DirectorDivision of NeonatologyChildren’s National Health SystemWashington, DC
Contributing EditorsKatherine Pham, PharmD, BCPS NICU Clinical SpecialistDirector-Pharmacy Residency ProgramsChildren’s National Health SystemDivision of PharmacyWashington, DC
Sara Rooney, PharmD, BCPSPICU Clinical SpecialistChildren’s National Health SystemDivision of PharmacyWashington, DC
CONTENTS
Introduction ............................................................................................... ix
1. CONVERSIONS .......................................................................................1Conversion Formulas .......................................................................... 1Temperature Conversion .................................................................... 2
Fahrenheit to Celsius Conversion ................................................. 2
2. SCALES AND SCORING ..........................................................................3Apgar Score .......................................................................................... 3New Ballard Score ............................................................................... 4Pain Scales ............................................................................................ 6
FLACC Pain Scale ........................................................................... 6Pediatric Early Warning Score (PEWS) ........................................ 7
3. GROWTH ...............................................................................................9Determining Body Surface Area ........................................................ 9Growth Charts .................................................................................... 10Growth Charts for Children With Special Health Care Needs ...... 38Growth Measures for Extremities/Ear Above Eye Levels ............... 44Primary Teeth Eruption Chart.......................................................... 51
4. BLOOD PRESSURE ................................................................................53Blood Pressure Nomograms ............................................................. 53
Healthy Term Newborns During the First 12 Hours of Life ........................................................................................ 53
Preterm and Full-term Newborns During the First Day of Life (According to Birth Weight) ....................................... 54
Preterm and Full-term Newborns During the First Day of Life (According to Gestational Age) .................................. 55
Preterm and Full-term Newborns According to Post-conceptional Age ............................................................. 56
Children Younger Than 1 Year .................................................... 57Blood Pressure Levels for Boys by Age and Height Percentile ...... 58Blood Pressure Levels for Girls by Age and Height Percentile ...... 61
vi Reference Range Values for Pediatric Care
5. REFERENCE RANGE VALUES .................................................................65Cerebrospinal Fluid ........................................................................... 65Clinical Chemistry ............................................................................. 68Newborn Clinical Chemistry ............................................................. 82Hematology ........................................................................................ 84Coagulation Tests ............................................................................... 86
Healthy Full-term Infant During the First 6 Months of Life ........................................................................................ 86
Inhibition of Coagulation in the Healthy Full-term Infant During the First 6 Months of Life ................................ 88
Healthy Preterm Infants (30 to 36 Weeks’ Gestation) During the First 6 Months of Life ........................................... 89
Inhibition of Coagulation in Healthy Preterm Infants (30 to 36 Weeks’ Gestation) During the First 6 Months of Life ........................................................................................ 90
Healthy Children Aged 1 to 16 Years Compared With Adults ............................................................................... 91
Inhibition of Coagulation in Healthy Children Aged 1 to 16 Years Compared With Adults ...................................... 92
Fibrinolytic System in Healthy Children Aged 1 to 16 Years Compared With Adults .............................................. 93
Lymphocyte Subset Counts in Peripheral Blood ............................ 94Thyroid Function Tests ..................................................................... 97
Very Low Birth Weight Infants .................................................... 97Preterm Infants ............................................................................. 97Infants, Children, and Adults ...................................................... 98
Endocrine Laboratory Values ........................................................... 99Growth Hormone Values ............................................................. 998 am Cortisol Levels ..................................................................... 99Serum 17 Hydroxyprogesterone ............................................... 100
6. HYPERBILIRUBINEMIA MANAGEMENT .................................................101Risk Nomogram ............................................................................... 101Phototherapy Nomogram ............................................................... 102Exchange Transfusion Nomogram ................................................. 103
viiContents
7. RATE AND GAP CALCULATIONS .........................................................105Glucose Infusion Rate ..................................................................... 105Calculated Serum Osmolality ........................................................ 105Anion Gap ....................................................................................... 105
8. NUTRITION, FORMULA PREPARATION, AND CALORIC COUNTS ..........107Preparation of Infant Formula for Standard and
Soy Formulas ................................................................................ 107Common Caloric Supplements ...................................................... 108Enteral Formulas, Including Their Main
Nutrient Components ................................................................. 108Composition of Fluids Frequently Used in Oral Rehydration ..... 116Dietary Reference Intakes ............................................................... 117Fluoride Sources and Supplementation ........................................ 119
9. UMBILICAL VEIN AND ARTERY CATHETERIZATION MEASUREMENTS ....121Using Birth Weight to Measure Catheter Length ......................... 121Using Shoulder-Umbilical Length to Measure Umbilical
Artery Catheter Length ............................................................... 123Using Shoulder-Umbilical Length to Measure Umbilical
Vein Catheter Length .................................................................. 124
10. DOSES AND LEVELS OF COMMON ANTI BIOTIC AND ANTISEIZURE MEDICATIONS...............................................................125Antibiotics ........................................................................................ 126Antiseizure ....................................................................................... 134
11. APPENDIXES ......................................................................................143Acetaminophen Toxicity Nomogram ............................................. 144Rabies Guidelines ............................................................................ 145Immunization Schedules ................................................................ 146Periodicity Schedule ................................................................... insertFrench Catheter Scale ................................................................ insert
ix
INTRODUCTION
Reference Range Values for Pediatric Care was created in response to an overwhelming need from pediatricians, pediatric residents, nurse practitioners, and other pediatric providers who acknowledged the utility of the reference range values section in Quick Reference Guide to Pediatric Care, part of the American Academy of Pediatrics (AAP) point-of-care offerings, which also include the AAP Textbook of Pediatric Care and Pediatric Care Online. Pediatricians have been quick to recog-nize both the ease of accessibility and breadth of knowledge that the Pediatric Care series allows, even as they continued to make “normal values” the most searched-for term in the series. As an answer to this, and in our effort to strike the ultimate balance between the practical and the comprehensive, we decided to develop a short stand-alone handbook of reference range values. This handbook was designed with the busy practitioner in mind. Compact and clear-cut, it provides the most commonly used reference range values, charts, and formulas at your fingertips. The values span the gamut of age groups from newborn to adolescence, with a particu-lar emphasis throughout on the values needed for the management of preterm newborns younger than 37 weeks. This focus is complemented by sections that address common newborn scores (eg, Apgar, Ballard) as well as the AAP newborn hyperbilirubinemia management charts. We have also included a new section for the series on commonly used antibiotics and antiseizure medications with recommended serum drug target levels; preterm and neonatal populations are highlighted to benefit the pediatrician responsible for the complex dosing for this age group. To that effect, we enlisted the help of 2 experienced pediatric pharmacists as contributing editors, Katherine Pham PharmD, BCPS, and Sara Rooney PharmD, BCPS. Additionally, the handbook features pain scales, growth measures for extremities, and the AAP immuniza-tion and periodicity schedules. In writing Reference Range Values for Pediatric Care, I would like to thank 4 integral people without whom this book would not have come to light. Firstly, I am indebted to Dr Deborah Campbell, Division Chief
x Reference Range Values for Pediatric Care
of Neonatology at the Children’s Hospital at Montefiore, for all her help with the inception of the original chapter and, subsequently, this handbook. I would also like to thank Martha Cook for coalescing the concept of this book alongside Mark Grimes and the AAP editorial team. Lastly, I would like to thank Alain Park for his keen eye, fantastic input, and for keeping me on track during development. I’d also like to give a special thanks to Drs Jennifer Chapman (pediatric emergency medicine), Aisha Davis (hospitalist division), and Kristin Arcana (pediatric endocrinology) at Children’s National Health System for their thorough review and valuable contribution to the text. As we strive to improve the health of all children, I hope this book is another little step to that end. Be on the lookout for the upcoming app!
Lamia Soghier, MD, FAAP
1
1. Conversions
CONVERSION FORMULAS
Height (length)1 mm = 0.04 in1 cm = 0.4 in
1 in = 2.54 cm1 m = 39.37 in
Weight60 mg = 1 g28.35 g = 1 oz453.6 g = 1 lb1,000 g = 1 kg1 kg = 2.2046 lb
1 L = 1.06 qt1 fl oz = 29.57 mL1 tbsp = 15 mL1 tsp = 5 mL
Milligram–milliequivalent conversionsmEq/L = mg/L × valence/atomic weightEquivalent weight = atomic weight/
valence
mg/L = mEq/L × atomic weight/valence
Milligram-millimole conversionsmmol/L = mg/L ÷ molecular weight
MilliosmolsThe milliequivalent (mEq) is roughly equivalent to the milliosmol (mOsm), the unit of measure of osmotic pressure or tonicity. One osmole (Osm) is the amount of a substance that dissociates in solution to form one mole (mol) of osmotically active particles.
2 Reference Range Values for Pediatric Care
TEMPERATURE CONVERSION
Celsius: ºC = 5/9 (ºF − 32)Fahrenheit: ºF = 9/5 (ºC + 32)
Fahrenheit to Celsius Conversion
ºF ºC ºF ºC ºF ºC ºF ºC ºF ºC125 51.6 92 33.3 59 15.0 26 -3.3 -7 -21.6124 51.1 91 32.7 58 14.4 25 -3.9 -8 -22.2123 50.5 90 32.2 57 13.9 24 -4.4 -9 -22.8122 50.0 89 31.6 56 13.3 23 -5.0 -10 -23.3121 49.4 88 31.1 55 12.8 22 -5.6 -11 -23.9120 48.8 87 30.5 54 12.2 21 -6.1 -12 -24.4119 48.3 86 30.0 53 11.7 20 -6.7 -13 -25.0118 47.7 85 29.4 52 11.1 19 -7.2 -14 -25.5117 47.2 84 28.9 51 10.5 18 -7.8 -15 -26.1116 46.6 83 28.3 50 10.0 17 -8.3 -16 -26.6115 46.1 82 27.8 49 9.4 16 -8.9 -17 -27.2114 45.5 81 27.2 48 8.9 15 -9.4 -18 -27.8113 45.0 80 26.6 47 8.3 14 -10.0 -19 -28.3112 44.4 79 26.1 46 7.8 13 -10.5 -20 -28.9111 43.8 78 25.5 45 7.2 12 -11.1 -21 -29.4110 43.3 77 25.0 44 6.7 11 -11.7 -22 -30.0109 42.7 76 24.4 43 6.1 10 -12.2 -23 -30.5108 42.2 75 23.9 42 5.6 9 -12.8 -24 -31.1107 41.6 74 23.3 41 5.0 8 -13.3 -25 -31.6106 41.1 73 22.8 40 4.4 7 -13.9 -26 -32.2105 40.5 72 22.2 39 3.9 6 -14.4 -27 -32.7104 40.0 71 21.6 38 3.3 5 -15.0 -28 -33.3103 39.4 70 21.1 37 2.8 4 -15.5 -29 -33.9102 38.9 69 20.5 36 2.2 3 -16.1 -30 -34.4101 38.3 68 20.0 35 1.7 2 -16.7 -31 -35.0100 37.7 67 19.4 34 1.1 1 -17.2 -32 -35.5
99 37.2 66 18.9 33 0.6 0 -17.8 -33 -36.198 36.6 65 18.3 32 0.0 -1 -18.3 -34 -36.697 36.1 64 17.8 31 -0.6 -2 -18.9 -35 -37.296 35.5 63 17.2 30 -1.1 -3 -19.4 -36 -37.795 35.0 62 16.7 29 -1.7 -4 -20.0 -37 -38.394 34.4 61 16.1 28 -2.2 -5 -20.5 -38 -38.993 33.9 60 15.5 27 -2.8 -6 -21.1 -39 -39.4
-40 -40.0
3
2. Scales and Scoring
APGAR SCORE
0 Points 1 Point 2 PointsPoints Totaled
Activity (muscle tone)
Limp Some flexion Active motion
Pulse Absent <100 beats/min>100 beats/min
Grimace (reflex irritability)
No response GrimaceCry or active withdrawal
Appearance (skin color/complexion)
Pale or blueAcrocyanotic (body pink, extremities blue
Completely pink
Respiration/Breathing
AbsentWeak cry; hypo-ventilation
Good;crying
Severely depressed 0–3
Moderately depressed 4–6
Excellent condition 7–10
4 Reference Range Values for Pediatric Care
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6 Reference Range Values for Pediatric Care
PAIN SCALES
FLACC Pain ScaleEach of the 5 categories is scored from 0 to 2: (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability. The total score will be between 0 and 10.
For pediatric/preverbal (validated 2 months to 7 years)Not valid for children with developmental delay
CATEGORY SCORING0 1 2
Face No particular expres-sion or smile
Occasional grimace or frown, withdrawn, disinterested
Frequent to constant quivering chin, clenched jaw
Legs Normal position or relaxed
Uneasy, restless, tense
Kicking or legs drawn up
Activity Lying quietly, normal position, moves easily
Squirming, shifting back and forth, tense
Arched, rigid, or jerking
Cry No cry (awake or asleep)
Moans or whimpers; occasional complaint
Crying steadily, screams or sobs, frequent complaints
Consolability Content, relaxed Reassured by occasional touching, hugging, or being talked to; distractible
Difficult to console or comfort
The FLACC Behavioral Scale for Postoperative Pain in Young Children. Merkel Sl, et al. (1997).
The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23(3), 293–297.
Wong-Baker FACES® Foundation (2014). Wong-Baker FACES® Pain Rating Scale. Retrieved January 1, 2014, with permission from http://www.WongBakerFACES.org.
7Scales and Scoring
Pediatric Early Warning Score (PEWS)
0 1 2 3 ScoreBehavior Playing/
AppropriateSleeping Irritable Lethargic/
confusedORReduced response to pain
Cardio-vascular
PinkORCapillary refill 1–2 seconds
Pale or duskyORCapillary refill3 seconds
Grey or cyanoticORCapillary refill 4 secondsORTachycardia of 20 beats/min above normal rate
Grey or cyanotic and mottledORCapillary refill 5 seconds or aboveORTachycardia of 30 beats/min above normal rateORBradycardia
Respiratory Within normal parameters, no retrac-tions
>10 breaths/min above normal param-etersORUsing accessory musclesOR30+%Fio2 or 3+ liters/min
>20 breaths/min above normal parametersORRetractionsOR40+%Fio2 or 6+ liters/min
≥5 breaths/min below normal pa-rameters with retractions, or, gruntingOR50+%Fio2 or 8+ liters/min
• Score by starting with the most severe parameters first.
• Score 2 extra for every 15-minute nebs (includes continuous nebs) or persistent postoperative vomiting.
• Use “liters/min” to score regular nasal cannula.
• Use “Fio2” to score a high flow nasal cannula.
Adapted from Monaghan A. Detecting and managing deterioration in children. Paedriatic Nursing. 2005;17:32–35.
8 Reference Range Values for Pediatric Care
Heart Rate at Rest (beats/min)
Respiratory Rate at Rest (breaths/min)
Birth – 1 mo 100–180 40–60
1 – 12 mo 100–180 35–40
1 – 3 y 70–110 25–30
4 – 6 y 70–110 21–23
7 – 12 y 70–110 19–21
13 – 19 y 55–90 16–18
Pediatric Early Warning Score (PEWS), continued
9
3. Growth
DETERMINING BODY SURFACE AREABased on the nomogram, a straight line joining the patient’s height and weight will intersect the center column at the calculated body surface area (BSA). For children of normal height and weight, use the child’s weight in pounds, and then read across to the corresponding BSA in meters squared. Alternatively, you can use Mosteller’s formula.
Nomogram and equation to determine body surface area. From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
1.308070
60
50
40
30
25
20
15
109.08.07.06.0
5.0
4.0
3.0
2.5
2.0
1.5
1.0
1.201.101.00
.90
.80
.70
.60
.55
.50
.45
.40
.35
.30
.25
.20
.15
.10
240
180160140130120110100
90807060
5045403530
25
20181614
12
109876
5
4
3
902.01.91.81.71.61.51.41.31.21.11.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
80
60
70
50
30
40
20
15
10987
6
5
4
3
2
220
200190180170160150140130
120
110
100
90
80
70
60
50
40
30
85807570
65
55
50
45
40
35
302826
24
22
20
181716151413
12
19
60
cm in lbm2 kgFor children ofnormal height
and weight
Wei
ght i
n po
unds
Surfa
ce a
rea
in m
eter
s sq
uare
d
Height Weight
Height (cm) x Weight (kg)3600
Alternative (Mosteller’s formula)Surface area (m2) =
NomogramSA
10 Reference Range Values for Pediatric Care
GROWTH CHARTS Growth Charts 1289
APP
Birth to 24 months: GirlsLength-for-age and Weight-for-age percentiles
Published by the Centers for Disease Control and Prevention, November 1, 2009SOURCE: WHO Child Growth Standards (http://www.who.int/childgrowth/en)
98
95
90
75
50
25
1052
9895907550251052
11Growth
1290 Appendix A
Pediatric Nutrition, 7th Edition
12
Birth
40
38
36
32
20
19
18
17
16
15
14
13
in
HEAD
CIRCUMFERENCE
HEAD
CIRCUMFERENC
30
34
52
48
46
44
cm
20
19
18
in
17
Birth to 24 months: GirlsHead circumference-for-age andWeight-for-length percentiles
NAMERECORD #
42
44
46
52
50
cm
48
50
WEIGHT
WEIGHT
WEIGHT
WEIGHT
kg lb
WEIGHT
14
2018
1416
1210
8642
987
2
incmkglb1
3
WEIGHT
2224
101112
65
E
66 68 70 72 74 76 78 80 82 84 86 88 92 94 969810010210410610890 cmin
Published by the Centers for Disease Control and Prevention, November 1, 2009SOURCE: WHO Child Growth Standards (http://www.who.int/childgrowth/en)
Date Age CommentWeight Length Head Circ.
64
24232221201918
46 4850 52 54 56 58 60 62
987
222018
1416
2426283032343638404244
121314
151617
12
1011
464850
1819202122
65
2324 52
242628
9895907550
2510
52
989590
75
50
25
1052
11041 424039383735 36343332313029282726 43
4 LENGTH
12 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
Growth Charts 1293
APP
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
2 to 20 years: Girls
Stature Weight-for-age percentiles-for-age and
NAME
RECORD #
Revised and corrected November 21, 2000.
W
E
I
G
H
T
W
E
I
G
H
T
cm
150
155
160
165
170
175
180
185
190
lb
30
40
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
220
230
kg10
15
20
25
30
35
105
45
50
55
60
65
70
75
80
85
90
95
100
20
20
S
T
A
T
U
R
E
40
lb
30
40
50
60
70
80
S
T
A
T
U
R
E
62
42
44
46
48
60
58
52
54
56
in
30
32
34
36
38
40
50
74
76
72
70
68
66
64
62
60
in
kg10
15
20
25
30
35
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
12 13 14 15 16 17 18 19
AGE (YEARS)
AGE (YEARS)
160
cm 113 4 5 6 7 8 9 10
95
90
75
50
25
105
95
90
75
50
25
105
Date
Mother’s Stature Father’s Stature
Age Weight Stature BMI*
13Growth
Page 42 [ Series 11, No. 246
Figure 24. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Girls body mass index-for-age
14 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
1296 Appendix A
Pediatric Nutrition, 7th Edition
56
52
48
44
40
36
32
28
24
20
lb lb
56
52
48
44
40
36
32
28
24
20
60
in
cm
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47
kg kg
19
18
17
16
15
14
13
12
11
10
9
8
27
26
25
24
23
22
21
20
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
28
29
30
31
32
33
34
64
68
72
76kg lb
kg
kg lb
lb
80 85 90 95 100 105 110 115 120
Date Age Weight Stature Comments
50
25
75
90
95
510
85
STATURE
Weight-for-stature percentiles: GirlsNAME
RECORD #
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
15Growth
Growth Charts 1299
APP
2 to 20 years: Girls
Stature Weight-for-age percentiles-for-age and
NAME
RECORD #
W
E
I
G
H
T
W
E
I
G
H
T
S
T
A
T
U
R
E
S
T
A
T
U
R
E
kg10
15
20
25
30
35
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
cm
150
155
160
165
170
175
180
185
190
kg10
15
20
25
30
35
105
45
50
55
60
65
70
75
80
85
90
95
100
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
12 13 14 15 16 17 18 19 20
AGE (YEARS)
AGE (YEARS)
40
160
cm 113 4 5 6 7 8 9 10
90
75
50
25
10
90
75
50
25
10
97
3
97
3
lb
30
40
50
60
70
80
lb
30
40
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
220
230
Date
Mother’s Stature Father’s Stature
Age Weight Stature BMI*
62
42
44
46
48
60
58
52
54
56
in
30
32
34
36
38
40
50
74
76
72
70
68
66
64
62
60
in
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
Revised and corrected November 21, 2000.
3rd to 97th
16 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued1300 Appendix A
Pediatric Nutrition, 7th Edition
2 to 20 years: Girls
Body mass index-for-age percentilesNAME
RECORD #
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
2 543 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
26
24
22
20
18
16
14
12
kg/m2
28
26
24
22
20
18
16
14
12
kg/m2
30
32
34
BMI
BMI
AGE (YEARS)
13
15
17
19
21
23
25
27
13
15
17
19
21
23
25
27
29
31
33
35
Date Age Weight Stature BMI* Comments
90
85
75
50
10
25
97
3
95
3rd to 97th
17Growth
Appendix A
APP
Appendix A - 1Set I
18 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
1288 Appendix A
Pediatric Nutrition, 7th Edition
19Growth
Figure 21. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, 2 to 20 years: Boys stature-for-age and weight-for-age
Series 11, No. 246 [ Page 39
20 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued Series 11, No. 246 [ Page 41
Figure 23. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Boys body mass index-for-age
21Growth
Growth Charts 1295
APP
56
52
48
44
40
36
32
28
24
20
lb lb
56
52
48
44
40
36
32
28
24
20
60
in
cm
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47
kg kg
19
18
17
16
15
14
13
12
11
10
9
8
27
26
25
24
23
22
21
20
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
28
29
30
31
32
33
34
64
68
72
76kg lb
kg
kg lb
lb
80 85 90 95 100 105 110 115 120
Date Age Weight Stature Comments
95
50
25
75
90
95
510
85
STATURE
Weight-for-stature percentiles: BoysNAME
RECORD #
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
22 Reference Range Values for Pediatric Care Growth Charts 1297
APP
2 to 20 years: Boys
Stature Weight-for-age percentiles-for-age and
NAME
RECORD #
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
Revised and corrected November 21, 2000.
W
E
I
G
H
T
W
E
I
G
H
T
S
T
A
T
U
R
E
S
T
A
T
U
R
E
lb
30
40
50
60
70
80
lb
30
40
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
200
210
220
230
kg10
15
20
25
30
35
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
160
cm
cm
150
155
160
165
170
175
180
185
190
kg10
15
20
25
30
35
105
45
50
55
60
65
70
75
80
85
90
95
100
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
12 13 14 15 16 17 18 19 20
AGE (YEARS)
AGE (YEARS)
40
90
75
50
25
10
90
75
50
25
10
113 4 5 6 7 8 9 10
97
3
97
3
62
42
44
46
48
60
58
52
54
56
in
30
32
34
36
38
40
50
74
76
72
70
68
66
64
62
60
inDate
Mother’s Stature Father’s Stature
Age Weight Stature BMI*
Appendix A - 1Set II
3rd to 97th
GROWTH CHARTS, continued
23Growth
1298 Appendix A
Pediatric Nutrition, 7th Edition
2 to 20 years: Boys
Body mass index-for-age percentilesNAME
RECORD #
SOURCE: Developed b
(2000).
y the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion
http://www.cdc.gov/growthcharts
2 543 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
26
24
22
20
18
16
14
12
kg/m2
28
26
24
22
20
18
16
14
12
kg/m2
30
32
34
BMI
BMI
AGE (YEARS)
13
15
17
19
21
23
25
27
13
15
17
19
21
23
25
27
29
31
33
35
90
75
50
25
10
85
Date Age Weight Stature BMI* Comments
97
3
95
3rd to 97th
24 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
Neonatal Growth Curve — Girls, WeightA
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
90th
97th
75th
50th
25th
10th
3rd
B
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
C
Cen
timet
ers
Cen
timet
ers
D
From Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics. 2010;125(2):e214– e244
25Growth
Neonatal Growth Curve — Girls, Length and Head Circumference
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
90th
97th
75th
50th
25th
10th
3rd
B
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
90th97th
75th50th25th10th3rd
90th97th
75th
50th
25th
10th
3rd
Head Circumference
Length
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
Cen
timet
ers
Cen
timet
ers
90th
97th
75th
50th
25th
10th
3rd
D
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
90th97th
75th50th25th10th3rd
90th97th
75th
50th
25th
10th
3rd
From Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics. 2010;125(2):e214 – e244
26 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
C
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
Cen
timet
ers
Cen
timet
ers
90th
97th
75th
50th
25th
10th
3rd
D
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
FIGURE 1New gender-specific intrauterine growth curves for girls’ weight-for-age (A), girls’ length- and HC-for-age (B), boys’ weight-for-age (C), and boys’ length- andHC-for-age (D). Of note, 3rd and 97th percentiles on all curves for 23 weeks should be interpreted cautiously given the small sample size; for boys’ HC curveat 24 weeks, all percentiles should be interpreted cautiously because the distribution of data is skewed left. Adapted from Groveman.
Neonatal Growth Curve — Boys, Weight
From Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics. 2010;125(2):e214 – e244
27Growth500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
500
1000
1500
2000
2500
3000
3500
4000
4500
23 25 27 29 31 33 35 37 39 41
Weight, gm
Gestational Age, weeks
Cen
timet
ers
Cen
timet
ers
90th
97th
75th
50th
25th
10th
3rd
D
20
25
30
35
40
45
50
55
23 25 27 29 31 33 35 37 39 41Gestational Age, weeks
90th97th
75th50th25th10th3rd
90th97th
75th
50th
25th
10th
3rd
Head Circumference
Length
New gender-specific intrauterine growth curves for girls’ weight-for-age (A), girls’ length- and HC-for-age (B), boys’ weight-for-age (C), and boys’ length- andHC-for-age (D). Of note, 3rd and 97th percentiles on all curves for 23 weeks should be interpreted cautiously given the small sample size; for boys’ HC curveat 24 weeks, all percentiles should be interpreted cautiously because the distribution of data is skewed left. Adapted from Groveman.
Neonatal Growth Curve — Boys, Length and Head Circumference
From Olsen IE, Groveman S, Lawson ML, Clark R, Zemel B. New intrauterine growth curves based on U.S. data. Pediatrics. 2010;125(2):e214 – e244
28 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
Growth Charts 1313
Appendix A 1313
APP
Fig. A-4.2
Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.doi:10.1186/1471-2431-13-59
Fenton Preterm Growth Chart — Girls
© 2013 Fenton and Kim; licensee BioMed Central Ltd.
29Growth1312 Appendix A
Pediatric Nutrition, 7th Edition
Appendix A - 4
Fig. A-4.1
Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.doi:10.1186/1471-2431-13-59
Fenton Preterm Growth Chart — Boys
© 2013 Fenton and Kim; licensee BioMed Central Ltd.
30 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
Appendix A
Pediatric Nutrition, 7th Edition
Appendix A - 5
Fig. A-5.1Low Birth Weight Growth ChartsIHDP Low Birth Weight and Very Low Birth Weight Growth Charts
31Growth
Fig. A-5.2
32 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
Appendix A
Pediatric Nutrition, 7th Edition
Fig. A-5.5GROWTH CHARTS, continued
33Growth
Fig. A-5.6
34 Reference Range Values for Pediatric Care
GROWTH CHARTS, continued
1316 Appendix A
Pediatric Nutrition, 7th Edition
Fig. A-5.3
1320 Appendix A
Pediatric Nutrition, 7th Edition
Fig. A-5.7GROWTH CHARTS, continued
35Growth
Growth Charts 1317
Fig. A-5.4Fig. A-5.8
36 Reference Range Values for Pediatric Care
1320 Appendix A
Pediatric Nutrition, 7th Edition
Fig. A-5.7GROWTH CHARTS, continued
37Growth
Fig. A-5.8
38 Reference Range Values for Pediatric Care
GROWTH CHARTS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Several growth charts are available for children with special health care needs. Listed below are some charts for children with genetic condi-tions that can alter growth.
• Trisomy 21 (Down syndrome) (Cronk, 1988)• Prader-Willi syndrome (Holm, 1995)• Williams syndrome (Morris, 1988)• Cornelia de Lange syndrome (Kline, 1993)• Turner syndrome (Ranke, 1983; Lyon, 1985)• Rubinstein-Taybi syndrome (Stevens, 1990)• Marfan syndrome (Pyeritz, 1983; Pyertiz, 1985)• Achondroplasia (Horton, 1978)
Currently, the CDC recommends that clinicians use the regular CDC growth charts for assessment of all these children. The inherent limitations of studies performed in each of these specific populations (eg, small sample size, retrospective nature of data, presence of other congenital anomalies such as cardiac conditions, inability to ascertain the nutritional status of these children, lack of ethnic diversity, and old data) may not afford the clinician an accurate assessment of growth in these children. We have provided a sample of the Trisomy 21 growth chart, but clini-cians should be aware of the inherent limitations of this study.
39Growth
From Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–110.
Height and Weight for Girls With Down Syndrome (1–36 mo)
40 Reference Range Values for Pediatric Care
From Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–110.
Height and Weight for Girls With Down Syndrome (2–18 y)
GROWTH CHARTS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, continued
41Growth
Height and Weight for Boys With Down Syndrome (1–36 mo)
From Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–110.
42 Reference Range Values for Pediatric Care
GROWTH CHARTS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, continued
Height and Weight for Boys With Down Syndrome (2–18 y)
From Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–110.
43Growth
References Butler M, Lee P, Whitman, B, eds. Management of Prader-Willi Syndrome. 3rd ed. New York, NY: Springer-Verlag; 2006
Cronk C, Crocker AC, Pueschel SM, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–110
Health Resources and Services Administration. The CDC Growth Charts for Children With Special Health Care Needs Web site. http://depts.washington.edu/growth/cshcn/text/page2b.htm. Accessed on February 7, 2014
Horton WA, Rotter JI, Rimoin DL, et al. Standard growth curves for achondroplasia. J Pediatr. 1978;93(3):435–438
Kline AD, Barr M, Jackson LG. Growth manifestations in the Brachmann-deLange syn-drome. Am J Med Genet. 1993;47(7):1042–1049
Lyon AF, Preece MA, Grant DB. Growth curves for girls with Turner syndrome. Arch Dis Child. 1985;60(10):932–935
Morris CA, Demsey SA, Leonard CO, et al. Natural history of Williams syndrome: physical characteristics. J Pediat. 1988;113(2):318–326
Pyeritz RE. Marfan Syndrome and Related Disorders. In: Rimoin DL, Pyeritz RE, Korf B, eds. Emery and Rimoin’s Principles and Practice of Medical Genetics. 5th ed. New York, NY: Churchill Livingstone; 2006
Pyeritz RE. Growth and anthropometrics in the Marfan syndrome. In: Papadatos CJ, Bartsocas CS, eds. Endocrine Genetics and Genetics of Growth. New York, NY: Alan R. Liss Inc; 1985
Ranke MB, Pfluger H, Rosendahl W, et al. Turner syndrome: spontaneous growth in 150 cases and review of the literature. Eur J Pediatr. 1983;141(2):81–88
Stevens CA, Hennekam RC, Blackburn BL. Growth in the Rubinstein-Taybi syndrome. Am J Med Genet Suppl. 1990;6:51–55
44 Reference Range Values for Pediatric Care
GROWTH MEASURES FOR EXTREMITIES/EAR ABOVE EYE LEVELSThe following measures show the normal ranges for upper and lower extremities and level of ears for newborns. They can be used to determine abnormalities (eg, newborns with suspected genetic anomalies or children with contractures where full limb length may not be feasible). The illustrations show the optimal method to measure. The graph can be used to plot measurements and determine percentiles.
Upper Arm Length
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
45Growth
Forearm Length
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
46 Reference Range Values for Pediatric Care
Long Bone Length–Upper Limb
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
47Growth
Long Bone Length–Lower Limb
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
48 Reference Range Values for Pediatric Care
Lower Leg Length
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
49Growth
Ear Above Eye Level (Gestational Age)
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
50 Reference Range Values for Pediatric Care
Ear Above Eye Level (Birth Weight)
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC: Greenwood Genetic Center, 2011.
51Growth
PRIMARY TEETH ERUPTION CHARTdevelopment
Upper Teeth Erupt ShedCentral incisor 8-12 months 6-7 yearsLateral incisor 9-13 months 7-8 years
Canine (cuspid) 16-22 months 10-12 years
First molar 13-19 months 9-11 years
Second molar 23-33 months 10-12 years
Lower Teeth Erupt ShedSecond molar 23-31 months 10-12 years
First molar 14-18 months 9-11 years
Canine (cuspid) 17-23 months 9-12 yearsLateral incisor 10-16 months 7-8 yearsCentral incisor 6-10 months 6-7 years
Primary Teeth eruption Chart
Primary Teeth
From: American Dental Association. Tooth eruption: the primary teeth. J Am Dent Assoc. 2005;136(11):1619.Copyright © 2014 American Dental Association. All rights reserved. Reprinted with permission.
53
4. Blood Pressure
BLOOD PRESSURE NOMOGRAMS
Healthy Term Newborns During the First 12 Hours of Life
80
60
40
20
0 1 2 3 4 5
Systolic(torr)
A B
Diastolic(torr)
Birth Weight (kg) Birth Weight (kg)
Systolic(torr)
Pulse(torr)
80
60
40
20
0 1 2 3 4 5
80
60
40
20
0 1 2 3 4 5
80
60
40
20
0 1 2 3 4 5
A, Linear regressions (broken lines) and 95% confidence limits (solid lines) of systolic (top) and diastolic (bottom) aortic blood pressures on birth weight in 61 healthy term newborns during the first 12 hours after birth. For systolic pressure, y = 7.13x + 40.45; r = 0.79. For diastolic pressure, y = 4.81x + 22.18; r = 0.71. For both, n = 413 and p < .001. B, Linear regressions (broken lines) and 95% confidence limits (solid lines) of mean pressure (top) and pulse pressure (systolic-diastolic pressure amplitude) (bottom) on birth weight in 61 healthy term newborns during the first 12 hours after birth. For mean pressure, y = 5.16x + 29.80; n = 443; r = 0.80. For pulse pressure, y = 2.31x + 18.27; n = 413; r = 0.45. For both, p < .001.
From Versmold HT, Kitterman JA, Phibbs RH, Gregory GA, Tooley WH. Aortic blood pres-sure during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics. 1981;67(5):607– 613.
54 Reference Range Values for Pediatric Care
Preterm and Full-term Newborns During the First Day of Life (According to Birth Weight)
.750
0
10
20
30
40
50
60
70
80
90
1.000 1.250 1.500 1.750 2.000 2.250 2.500 2.750 3.000 3.250 3.500 3.750 4.000
Birth Weight (kg)
Lower 95% C.L.
Lower 95% C.L.
Upper 95% C.L.
Syst
olic
Blo
od P
ress
ure
(mm
Hg)
.750
0
10
20
30
40
50
60
70
1.000 1.250 1.500 1.750 2.000 2.250 2.500 2.750 3.000 3.250 3.500 3.750 4.000
Birth Weight (kg)
Upper 95% C.L.
Dia
stol
ic B
lood
Pre
ssur
e (m
m H
g)
A, Linear regression of mean systolic and diastolic blood pressures by birth weight on day 1 of life, with 95% confidence limits (CLs) (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright © 1995 Nature Publishing Group.
A
BLOOD PRESSURE NOMOGRAMS, continued
55Blood Pressure
Preterm and Full-term Newborns During the First Day of Life (According to Gestational Age)
22 24 26 28 30 32 34 36 38 40 42
0
10
20
30
40
50
60
70
80
90
Gestational Age (weeks)
Lower 95% C.L.
Upper 95% C.L.
Upper 95% C.L.
Syst
olic
Blo
od P
ress
ure
(mm
Hg)
22 24 26 28 30 32 34 36 38 40 42
0
10
20
30
40
50
60
70
Gestational Age (weeks)
Lower 95% C.L.
Dia
stol
ic B
lood
Pre
ssur
e (m
m H
g)
B, Linear regression of mean systolic and diastolic blood pressures by gestational age on day 1 of life, with 95% confidence limits (CLs) (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright © 1995 Nature Publishing Group.
B
56 Reference Range Values for Pediatric Care
C
BLOOD PRESSURE NOMOGRAMS, continued
Preterm and Full-term Newborns According to Post- conceptional Age
C, Linear regression of mean systolic and diastolic blood pressures by postconceptual age in weeks, with 95% confidence limits (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, et al. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright © 1995 Nature Publishing Group.
24 26 28 30 32 34 36 38 40 42 44 46
0
10
20
30
40
50
60
70
80
90
100
110
24 26 28 30 32 34 36 38 40 42 44 46
0
10
20
30
40
50
60
70
80
90
100
Post Conceptional Age (weeks)
Post Conceptional Age (weeks)
Lower 95% C.L.
Upper 95% C.L.
Upper 95% C.L.
Syst
olic
Blo
od P
ress
ure
(mm
Hg)
Lower 95% C.L.
Dia
stol
ic B
lood
Pre
ssur
e (m
m H
g)
57Blood Pressure
Children Younger Than 1 Year
115110105100
95908580757065
0 1 2 3 4 5MONTHS
6 7 8 9 10 11 12
SYST
OLI
C B
P
115110105100
95908580757065
0 1 2 3 4 5MONTHS
6 7 8 9 10 11 12
SYST
OLI
C B
P
75
70
65
60
55
50
45
0 1 2 3 4 5MONTHS
6 7 8 9 10 11 12
DIA
STO
LIC
BP
(K4)
75
70
65
60
55
50
45
0 1 2 3 4 5MONTHS
6 7 8 9 10 11 12
DIA
STO
LIC
BP
(K4)
50th
75th
90th95th
50th
75th
90th95th
50th
75th
90th
95th
50th
75th
90th
95th
76 98 101 104 105 106 106 106 106 106 108 105 105
68 65 64 64 65 66 66 66 66 67 67 67 67
54 55 56 58 51 63 66 68 70 72 74 75 77
4 4 4 5 5 6 7 8 9 9 10 10 11
90th Percentile
Systolic BP 87 101 106 106 106 105 105 106 105 105 105 105 105
Diastolic BP 68 65 63 63 63 65 66 67 68 68 69 69 69
Height CM 51 59 63 66 68 70 72 73 74 75 77 78 80
Weight KG 4 4 5 5 6 7 8 9 9 10 10 11 11
A, Age-specific percentiles of blood pressure (BP) measurements in boys—birth to 12 months of age; Korotkoff phase IV (K4) used for diastolic BP. B, Age-specific percentiles of blood pressure (BP) measurements in girls—birth to 12 months of age; Korotkoff phase IV (K4) used for diastolic BP.
From Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood Pressure Control in Children—1987. Pediatrics. 1987;79(1):1–25.
58 Reference Range Values for Pediatric Care
BLOOD PRESSURE LEVELS FOR BOYS BY AGE AND HEIGHT PERCENTILE
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
1 50th 80 81 83 85 87 88 89 34 35 36 37 38 39 39
90th 94 95 97 99 100 102 103 49 50 51 52 53 53 54
95th 98 99 101 103 104 106 106 54 54 55 56 57 58 58
99th 105 106 108 110 112 113 114 61 62 63 64 65 66 66
2 50th 84 85 87 88 90 92 92 39 40 41 42 43 44 44
90th 97 99 100 102 104 105 106 54 55 56 57 58 58 59
95th 101 102 104 106 108 109 110 59 59 60 61 62 63 63
99th 109 110 111 113 115 117 117 66 67 68 69 70 71 71
3 50th 86 87 89 91 93 94 95 44 44 45 46 47 48 48
90th 100 101 103 105 107 108 109 59 59 60 61 62 63 63
95th 104 105 107 109 110 112 113 63 63 64 65 66 67 67
99th 111 112 114 116 118 119 120 71 71 72 73 74 75 75
4 50th 88 89 91 93 95 96 97 47 48 49 50 51 51 52
90th 102 103 105 107 109 110 111 62 63 64 65 66 66 67
95th 106 107 109 111 112 114 115 66 67 68 69 70 71 71
99th 113 114 116 118 120 121 122 74 75 76 77 78 78 79
5 50th 90 91 93 95 96 98 98 50 51 52 53 54 55 55
90th 104 105 106 108 110 111 112 65 66 67 68 69 69 70
95th 108 109 110 112 114 115 116 69 70 71 72 73 74 74
99th 115 116 118 120 121 123 123 77 78 79 80 81 81 82
6 50th 91 92 94 96 98 99 100 53 53 54 55 56 57 57
90th 105 106 108 110 111 113 113 68 68 69 70 71 72 72
95th 109 110 112 114 115 117 117 72 72 73 74 75 76 76
99th 116 117 119 121 123 124 125 80 80 81 82 83 84 84
7 50th 92 94 95 97 99 100 101 55 55 56 57 58 59 59
90th 106 107 109 111 113 114 115 70 70 71 72 73 74 74
95th 110 111 113 115 117 118 119 74 74 75 76 77 78 78
99th 117 118 120 122 124 125 126 82 82 83 84 85 86 86
8 50th 94 95 97 99 100 102 102 56 57 58 59 60 60 61
90th 107 109 110 112 114 115 116 71 72 72 73 74 75 76
95th 111 112 114 116 118 119 120 75 76 77 78 79 79 80
99th 119 120 122 123 125 127 127 83 84 85 86 87 87 88
59Blood Pressure
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
9 50th 95 96 98 100 102 103 104 57 58 59 60 61 61 62
90th 109 110 112 114 115 117 118 72 73 74 75 76 76 77
95th 113 114 116 118 119 121 121 76 77 78 79 80 81 81
99th 120 121 123 125 127 128 129 84 85 86 87 88 88 89
10 50th 97 98 100 102 103 105 106 58 59 60 61 61 62 63
90th 111 112 114 115 117 119 119 73 73 74 75 76 77 78
95th 115 116 117 119 121 122 123 77 78 79 80 81 81 82
99th 122 123 125 127 128 130 130 85 86 86 88 88 89 90
11 50th 99 100 102 104 105 107 107 59 59 60 61 62 63 63
90th 113 114 115 117 119 120 121 74 74 75 76 77 78 78
95th 117 118 119 121 123 124 125 78 78 79 80 81 82 82
99th 124 125 127 129 130 132 132 86 86 87 88 89 90 90
12 50th 101 102 104 106 108 109 110 59 60 61 62 63 63 64
90th 115 116 118 120 121 123 123 74 75 75 76 77 78 79
95th 119 120 122 123 125 127 127 78 79 80 81 82 82 83
99th 126 127 129 131 133 134 135 86 87 88 89 90 90 91
13 50th 104 105 106 108 110 111 112 60 60 61 62 63 64 64
90th 117 118 120 122 124 125 126 75 75 76 77 78 79 79
95th 121 122 124 126 128 129 130 79 79 80 81 82 83 83
99th 128 130 131 133 135 136 137 87 87 88 89 90 91 91
14 50th 106 107 109 111 113 114 115 60 61 62 63 64 65 65
90th 120 121 123 125 126 128 128 75 76 77 78 79 79 80
95th 124 125 127 128 130 132 132 80 80 81 82 83 84 84
99th 131 132 134 136 138 139 140 87 88 89 90 91 92 92
15 50th 109 110 112 113 115 117 117 61 62 63 64 65 66 66
90th 122 124 125 127 129 130 131 76 77 78 79 80 80 81
95th 126 127 129 131 133 134 135 81 81 82 83 84 85 85
99th 134 135 136 138 140 142 142 88 89 90 91 92 93 93
16 50th 111 112 114 116 118 119 120 63 63 64 65 66 67 67
90th 125 126 128 130 131 133 134 78 78 79 80 81 82 82
95th 129 130 132 134 135 137 137 82 83 83 84 85 86 87
99th 136 137 139 141 143 144 145 90 90 91 92 93 94 94
60 Reference Range Values for Pediatric Care
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
17 50th 114 115 116 118 120 121 122 65 66 66 67 68 69 70
90th 127 128 130 132 134 135 136 80 80 81 82 83 84 84
95th 131 132 134 136 138 139 140 84 85 86 87 87 88 89
99th 139 140 141 143 145 146 147 92 93 93 94 95 96 97
Abbreviation: BP, blood pressure.
Note: The 90th percentile is 1.28 SD, the 95th percentile is 1.645 SD, and the 99th percentile is 2.326 SD over the mean.
BLOOD PRESSURE LEVELS FOR BOYS BY AGE AND HEIGHT PERCENTILE, continued
61Blood Pressure
BLOOD PRESSURE LEVELS FOR GIRLS BY AGE AND HEIGHT PERCENTILE
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 10th 25th 50th 75th 90th 95th 95th
1 50th 83 84 85 86 88 89 90 38 39 39 40 41 41 42
90th 97 97 98 100 101 102 103 52 53 53 54 55 55 56
95th 100 101 102 104 105 106 107 56 57 57 58 59 59 60
99th 108 108 109 111 112 113 114 64 64 65 65 66 67 67
2 50th 85 85 87 88 89 91 91 43 44 44 45 46 46 47
90th 98 99 100 101 103 104 105 57 58 58 59 60 61 61
95th 102 103 104 105 107 108 109 61 62 62 63 64 65 65
99th 109 110 111 112 114 115 116 69 69 70 70 71 72 72
3 50th 86 87 88 89 91 92 93 47 48 48 49 50 50 51
90th 100 100 102 103 104 106 106 61 62 62 63 64 64 65
95th 104 104 105 107 108 109 110 65 66 66 67 68 68 69
99th 111 111 113 114 115 116 117 73 73 74 74 75 76 76
4 50th 88 88 90 91 92 94 94 50 50 51 52 52 53 54
90th 101 102 103 104 106 107 108 64 64 65 66 67 67 68
95th 105 106 107 108 110 111 112 68 68 69 70 71 71 72
99th 112 113 114 115 117 118 119 76 76 76 77 78 79 79
5 50th 89 90 91 93 94 95 96 52 53 53 54 55 55 56
90th 103 103 105 106 107 109 109 66 67 67 68 69 69 70
95th 107 107 108 110 111 112 113 70 71 71 72 73 73 74
99th 114 114 116 117 118 120 120 78 78 79 79 80 81 81
6 50th 91 92 93 94 96 97 98 54 54 55 56 56 57 58
90th 104 105 106 108 109 110 111 68 68 69 70 70 71 72
95th 108 109 110 111 113 114 115 72 72 73 74 74 75 76
99th 115 116 117 119 120 121 122 80 80 80 81 82 83 83
7 50th 93 93 95 96 97 99 99 55 56 56 57 58 58 59
90th 106 107 108 109 111 112 113 69 70 70 71 72 72 73
95th 110 111 112 113 115 116 116 73 74 74 75 76 76 77
99th 117 118 119 120 122 123 124 81 81 82 82 83 84 84
8 50th 95 95 96 98 99 100 101 57 57 57 58 59 60 60
90th 108 109 110 111 113 114 114 71 71 71 72 73 74 74
95th 112 112 114 115 116 118 118 75 75 75 76 77 78 78
99th 119 120 121 122 123 125 125 82 82 83 83 84 85 86
62 Reference Range Values for Pediatric Care
BLOOD PRESSURE LEVELS FOR GIRLS BY AGE AND HEIGHT PERCENTILE, continued
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 10th 25th 50th 75th 90th 95th 95th
9 50th 96 97 98 100 101 102 103 58 58 58 59 60 61 61
90th 110 110 112 113 114 116 116 72 72 72 73 74 75 75
95th 114 114 115 117 118 119 120 76 76 76 77 78 79 79
99th 121 121 123 124 125 127 127 83 83 84 84 85 86 87
10 50th 98 99 100 102 103 104 105 59 59 59 60 61 62 62
90th 112 112 114 115 116 118 118 73 73 73 74 75 76 76
95th 116 116 117 119 120 121 122 77 77 77 78 79 80 80
99th 123 123 125 126 127 129 129 84 84 85 86 86 87 88
11 50th 100 101 102 103 105 106 107 60 60 60 61 62 63 63
90th 114 114 116 117 118 119 120 74 74 74 75 76 77 77
95th 118 118 119 121 122 123 124 78 78 78 79 80 81 81
99th 125 125 126 128 129 130 131 85 85 86 87 87 88 89
12 50th 102 103 104 105 107 108 109 61 61 61 62 63 64 64
90th 116 116 117 119 120 121 122 75 75 75 76 77 78 78
95th 119 120 121 123 124 125 126 79 79 79 80 81 82 82
99th 127 127 128 130 131 132 133 86 86 87 88 88 89 90
13 50th 104 105 106 107 109 110 110 62 62 62 63 64 65 65
90th 117 118 119 121 122 123 124 76 76 76 77 78 79 79
95th 121 122 123 124 126 127 128 80 80 80 81 82 83 83
99th 128 129 130 132 133 134 135 87 87 88 89 89 90 91
14 50th 106 106 107 109 110 111 112 63 63 63 64 65 66 66
90th 119 120 121 122 124 125 125 77 77 77 78 79 80 80
95th 123 123 125 126 127 129 129 81 81 81 82 83 84 84
99th 130 131 132 133 135 136 136 88 88 89 90 90 91 92
15 50th 107 108 109 110 111 113 113 64 64 64 65 66 67 67
90th 120 121 122 123 125 126 127 78 78 78 79 80 81 81
95th 124 125 126 127 129 130 131 82 82 82 83 84 85 85
99th 131 132 133 134 136 137 138 89 89 90 91 91 92 93
63Blood Pressure
Abbreviation: BP, blood pressure.
Note: The 90th percentile is 1.28 SD, the 95th percentile is 1.645 SD, and the 99th percentile is 2.326 SD over the mean.
Systolic BP (mm Hg)← Percentile of Height →
Diastolic BP (mm Hg)← Percentile of Height →
Age (Year)
BPPercen-tile 5th 10th 25th 50th 75th 90th 95th 10th 25th 50th 75th 90th 95th 95th
16 50th 108 108 110 111 112 114 114 64 64 65 66 66 67 68
90th 121 122 123 124 126 127 128 78 78 79 80 81 81 82
95th 125 126 127 128 130 131 132 82 82 83 84 85 85 86
99th 132 133 134 135 137 138 139 90 90 90 91 92 93 93
17 50th 108 109 110 111 113 114 115 64 65 65 66 67 67 68
90th 122 122 123 125 126 127 128 78 79 79 80 81 81 82
95th 125 126 127 129 130 131 132 82 83 83 84 85 85 86
99th 133 133 134 136 137 138 139 90 90 91 91 92 93 93
65
5. Reference Range Values
CEREBROSPINAL FLUID
ComponentPreterm Newborn
Full Term1–7 Days
Full Term8–30 Days
1–3 Months
4 Months– 16 Years Adult
Note: Entries listed in alphabetical order.
Color Clear or xantho-chromic
Clear or xantho chromic
Clear or xantho-chromic
Clear Clear Clear
Red blood cells (/mcL)
3–23 (0–1070)
White blood cells (/mcL)
<22–28 <30 <12 <6 <1 <5
Polymorpho-nuclear cells (/mcL)
<20e–60% <38–60% <10% None (36%–71%)
None (26%–35%)
None
Lymphocytes (/mcL)
0–20 (if <24 h) 0–4 (if 7 days)
≤11 ≤5 ≤5 60%–70%
Monocytes (/mcL)
<4 (50%–99%) ≤4 (50%–99%)
<4 (33%–67%)
<4 (44%–90%)
30%–50%
Protein (mg/dL), mean ± SD(95th percen-tile)
65–150 79 ± 23 (132) 68 ± 20 (100)
58 ± 17 (89) up to 42 days; 53 ± 17 (83) up to 56 days; 5– 45 after 56 days
5–45 5–45
Glucose (mg/dL)
24–63 (1.3– 3.5 mmol/L)
>50 (>2.77 mmol/L)
>50% in serum ≥38 (2.1 mmol/L)
≥45 (≥2.5 mmol/L)
45–72 (2.5–4.0 mmol/L), 60% in serum
2.2– 4.7 mmol/L
CSF glucose/blood glucose
0.55–1.05 ≥0.6 ≥0.6 ≥0.6 ≥0.6
66 Reference Range Values for Pediatric Care
ComponentPreterm Newborn
Full Term1–7 Days
Full Term8–30 Days
1–3 Months
4 Months– 16 Years Adult
Note: Entries listed in alphabetical order.
Lactate (mmol/L)
5–30 (approx 10% serum value)
<3.1 (if >2 days)
<3.1 <3.1 <2.4 (if 1–12 y)
Opening pressure (mm H2O) in lateral recumbent position
8–11 <28 <28 <28 50–180
CSF volume (mL)
60–100 100–160
Fluctuation with respiration
0.5–1.0 0.5–1.0 0.5–1.0 0.5–1.0 0.5–1.0
Abbreviation: CSF, Cerebral spinal fluid; SD, standard deviation.
Calculating the ratio of red blood cells (RBCs) to white blood cells (WBCs) in CSF General rule: For every 500 RBCs in CSF, it is acceptable to have 1 WBC. Normal ratio of RBCs to WBCs in peripheral blood is 1,000 RBCs: 1–2 WBCs × 106/L.
Number of WBCs introduced into the CSF per L = (WBC[peripheral] × RBC[CSF] )
× 106/L RBC(peripheral)
Compare this number with the actual number of WBCs in the CSF.1,000 × 106/L RBCs in CSF raises CSF protein by approximately 0.015 g/L.Note: correction factors should not be used to reassure that meningitis is unlikely.
67Reference Range Values
ReferencesAhmed A, Hickey SM, Ehrett S, et al. Cerebrospinal fluid values in the term neonate. Pediatr Infect Dis J. 1996;15(4):298
Avery RA, Shah SS, Licht DJ, Seiden JA, Huh JW, Boswinkel J, et al. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med. 2010;363(9):891–893
Biou D, Benoist J-F, Huong CN-TX, et al. Cerebrospinal fluid protein concentrations in children: age-related values in patients without disorders of the central nervous system. Clin Chem. 2000;46(3):399
Griffith BP, Booss J. Neurologic infections of the fetus and newborn. Neurol Clin.1994;12(3):541
Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS. Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants. Pediatrics. 2010;125(2):257–264
Lipton JD, Schafermeyer RW. Evolving concepts in pediatric bacterial meningitis—part I: pathophysiology and diagnosis. Ann Emerg Med. 1993;22(10):1602
McMillan JA, Oski FA, Feigin RD, et al, eds. Oski’s Pediatrics: Principles and Practice. 3rd ed. Philadelphia, PA: JB Lippincott; 1999.
Naidoo BT. The cerebrospinal fluid in the healthy newborn infant. S Afr Med J. 1968;42(35):933
Nascimento-Carvalho CMC, Moreno-Carvalho OA. Normal cerebrospinal fluid values in full-term gestation and premature neonates. Arq Neuropsiquiatr. 1998;56(3-A):375
Shah SS, Ebberson J, Kestenbaum LA, Hodinka RL, Zorc JJ. Age-specific reference values for cerebrospinal fluid protein concentration in neonates and young infants. J Hosp Med. 2011;6(1):22–27
Soldin JS, Brugnara C, Gunter KC, et al, eds. Pediatric Reference Ranges. 2nd ed. Washington, DC: AAAC Press; 1997.
Srinivasan L, Shah SS, Padula MA, Abbasi S, McGowan KL, Harris MC. Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit. J Pediatr. 2012;161(4):729–734
Wong M, Schlagger BL, Buller RS, et al. Cerebrospinal fluid protein concentration in pediatric patients: defining clinically relevant reference values. Arch Pediatr Adolesc Med. 2000;154:827
68 Reference Range Values for Pediatric Care
CLINICAL CHEMISTRY
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Acid phosphate
Newborn 7.4–19.4 U/L 7.4–19.4 U/L
2–13 y 6.4–15.2 U/L 6.4–15.2 U/L
Man 0.5–11.0 U/L 0.5–11.0 U/L
Woman 0.2–9.5 U/L 0.2–9.5 U/L
Alanine aminotransferase (ALT)
<5 d 6–50 U/L 6–50 U/L
<12 mo 13–45 U/L 13–45 U/L
1–3 y 5–45 U/L 5–45 U/L
4–6 y 10–25 U/L 10–25 U/L
7–9 y 10–35 U/L 10–35 U/L
Girl 10–11 y 10–30 U/L 10–30 U/L
Boy 10–11 y 10–35 U/L 10–35 U/L
Girl 12–13 y 10–30 U/L 10–30 U/L
Boy 12–13 y 10–55 U/L 10–55 U/L
Girl 14–15 y 5–30 U/L 5–30 U/L
Boy 14–15 y 10–45 U/L 10–45 U/L
Girl >16 y 5–35 U/L 5–35 U/L
Boy >16 y 10–40 U/L 10–40 U/L
Man 10–40 U/L 10–40 U/L
Woman 7–35 U/L 7–35 U/L
Aldolase
10–24 mo 3.4–11.8 U/L 3.4–11.8 U/L
2–16 y 1.2–8.8 U/L 1.2–8.8 U/L
Adult 1.7–4.9 U/L 1.7–4.9 U/L
69Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Alkaline phosphatase
Infant 150–420 U/L 150–420 U/L
2–10 y 100–320 U/L 100–320 U/L
Adolescent boy 100–390 U/L 100–390 U/L
Adolescent girl 100–320 U/L 100–320 U/L
Adult 30–120 U/L 30–120 U/L
Ammonia
Newborn 90–150 mcg/dL 64–107 mcmol/L
0–2 wk 79–129 mcg/dL 56–92 mcmol/L
>1 mo 29–70 mcg/dL 21–50 mcmol/L
Adult 15–45 mcg/dL 11–32 mcmol/L
Amylase
0–3 mo 0–30 U/L 0–30 U/L
3–6 mo 0–50 U/L 0–50 U/L
6–12 mo 0–80 U/L 0–80 U/L
>1 y 30–100 U/L 30–100 U/L
Adult 27–131 U/L 27–131 U/L
Antinuclear antibody
Negative <1:40
Patterns with clinical correlation:
Centromere: CREST
Nuclear: Scleroderma
Homogeneous: Systemic Lupus Erythematosus (SLE)
70 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Antistreptolysin O titer (ASOT) (fourfold rise in serial sample is significant)
Newborn Similar to mother’s value
6–24 mo ≤50 Todd units/mL
2–4 y ≤160 Todd units/mL
≥5 y ≤330 Todd units/mL
Aspartate aminotransferase (AST)
0–10 d 47–150 U/L 47–150 U/L
10 d–24 mo 9–80 U/L 9–80 U/L
Girl >24 mo 13–35 U/L 13–35 U/L
Boy >24 mo 15–40 U/L 15–40 U/L
Bicarbonate
Newborn 17–24 mEq/L 17–24 mmol/L
Infant 19–24 mEq/L 19–24 mEq/L
2 mo–2 y 16–24 mEq/L 16–24 mmol/L
>2 y 22–26 mEq/L 22–26 mmol/L
Bilirubin (total)
Cord
Preterm and term <2 mg/dL <34 mcmol/L
0–1 d
Preterm and term <8 mg/dL <137 mcmol/L
1–2 d
Preterm <12 mg/dL <205 mcmol/L
Term <11.5 mg/dL <197 mcmol/L
3–5 d
Preterm <16 mg/dL <274 mcmol/L
Term <12 mg/dL <205 mcmol/L
CLINICAL CHEMISTRY, continued
71Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Bilirubin (total), continued
Older infants
Preterm <2 mg/dL <34 mcmol/L
Term <1.2 mg/dL <21 mcmol/L
Adult <1.5 mg/dL <20.5 mcmol/L
Bilirubin (conjugated)
Neonate <0.6 mg/dL <10 mcmol/L
Infant/children <0.2 mg/dL <3.4 mcmol/L
pHPao2 (mm Hg)
Paco2 (mm Hg)
Hco3–
(mEq/L)
Blood gas, arterial (breathing room air)
Cord blood 7.28 ± 0.05 18.0 ± 6.2 49.2 ± 8.4 14–22
Newborn (birth) 7.11–7.36 8–24 27–40 13–22
5–10 min 7.09–7.30 33–75 27–40 13–22
30 min 7.21–7.38 31–85 27–40 13–22
60 min 7.26–7.49 55–80 27–40 13–22
1 d 7.29–7.45 54–95 27–40 13–22
Child/adult 7.35–7.45 83–108 32–48 20–28
Note: Venous blood gases can be used to assess acid-base status, not oxygenation. Pco2 averages 6 to 8 mm Hg higher than Paco2, and pH is slightly lower. Peripheral venous samples are strongly affected by the local circulatory and metabolic environment. Capillary blood gases correlate best with arterial pH and moderately well with Paco2.
72 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Calcium
Total
Preterm 6.2–11 mg/dL 1.55–2.75 mmol/L
Term <10 d 7.6–10.4 mg/dL 1.9–2.6 mmol/L
10 d–24 mo 9.0–11 mg/dL 2.25-2.75 mmol/L
2–12 y 8.8–10.8 mg/dL 2.2–2.7 mmol/L
12–18 y 8.4 –10.2 mg/dL 2.1–2.55 mmol/L
Ionized
0–1 mo 3.9–6.0 mg/dL 1.0–1.5 mmol/L
1–6 mo 3.7–5.9 mg/dL 0.95–1.5 mmol/L
1–18 y 4.9–5.5 mg/dL 1.22–1.37 mmol/L
Adult 4.75–5.3 mg/dL 1.18–1.32 mmol/L
Carbon dioxide (CO2 content) (see “Blood gas, arterial”)
Carbon monoxide (carboxyhemoglobin)
Nonsmoker 0.5%–1.5% of total hemo-globin
Smoker 4%–9% of total hemo-globin
Toxic 20%–50% of total hemo-globin
Lethal >50% of total hemoglobin
Chloride (serum)
0–6 mo 97–108 mEq/L 97–108 mmol/L
6–12 mo 97–106 mEq/L 97–106 mmol/L
Child/adult 97–107 mEq/L 97–107 mmol/L
C-reactive protein 0–0.5 mg/d
CLINICAL CHEMISTRY, continued
73Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Creatine kinase (creatine phosphokinase)
Newborn 145–1,578 U/L 145–1,578 U/L
>6 wk–man 20–200 U/L 20–200 U/L
>6 wk–woman 20–180 U/L 20–180 U/L
Creatinine (serum)
Cord 0.6–1.2 mg/dL 53–106 mcmol/L
Newborn 0.3–1.0 mg/dL 27–88 mcmol/L
Infant 0.2–0.4 mg/dL 18–35 mcmol/L
Child 0.3–0.7 mg/dL 27–62 mcmol/L
Adolescent 0.5–1.0 mg/dL 44–88 mcmol/L
Man 0.9–1.3 mg/dL 80–115 mcmol/L
Woman 0.6–1.1 mg/dL 53–97 mcmol/L
Erythrocyte sedimentation rate (ESR)
Child 0–10 mm/h
Man 0–15 mm/h
Woman 0–20 mm/h
Ferritin
Newborn 25–200 ng/mL 56–450 pmol/L
1 mo 200–600 ng/mL 450–1350 pmol/L
2–5 mo 50–200 ng/mL 112–450 pmol/L
6 mo–15 y 7–140 ng/mL 16–350 pmol/L
Man 20–250 ng/mL 45–562 pmol/L
Woman 10–120 ng/mL 22–270 pmol/L
Folate (serum)
Newborn 16–72 ng/mL 16–72 nmol/L
Child 4–20 ng/mL 4–20 nmol/L
Adult 10–63 ng/mL 10–63 nmol/L
74 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Folate (red blood cells)
Newborn 150–200 ng/mL 340–453 nmol/L
Infant 74–995 ng/mL 168–2,254 nmol/L
2–16 y >160 ng/mL >362 nmol/L
>16 y 140–628 ng/mL 317–1422 nmol/L
Galactose
Newborn 0–20 mg/dL 0–1.11 mmol/L
Older child <5 mg/dL <0.28 mmol/L
γ-Glutamyl transferase (GGT)
Cord 37–193 U/L 37–193 U/L
0–1 mo 13–147 U/L 13–147 U/L
1–2 mo 12–123 U/L 12–123 U/L
2–4 mo 8–90 U/L 8–90 U/L
4 mo–10 y 5–32 U/L 5–32 U/L
10–15 y 5–24 U/L 5–24 U/L
Man 11–49 U/L 11–49 U/L
Woman 7–32 U/L 7–32 U/L
Glucose (serum)
Preterm 20–60 mg/dL 1.1–3.3 mmol/L
Newborn <1 day 40–60 mg/dL 2.2–3.3 mmol/L
Newborn >1 day 50–90 mg/dL 2.8–5.0 mmol/L
Child 60–100 mg/dL 3.3–5.5 mmol/L
>16 y 70–105 mg/dL 3.9–5.8 mmol/L
Haptoglobin
Newborn 5–48 mg/dL 50–480 mg/dL
>30 d 26–185 mg/dL 260–1850 mg/dL
CLINICAL CHEMISTRY, continued
75Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Hemoglobin A1c
Normal 4.5%–5.6%
At risk for diabetes 5.7%–6.4%
Diabetes mellitus ≥6.5%
Hemoglobin F, % total hemoglobin [mean (SD)]
1 d 77.0 (7.3)
5 d 76.8 (5.8)
3 wk 70.0 (7.3)
6–9 wk 52.9 (11)
3–4 mo 23.2 (16)
6 mo 4.7 (2.2)
8–11 mo 1.6 (1.0)
Adult <2.0
Iron
Newborn 100–250 mcg/dL 17.9–44.8 mcmol/L
Infant 40–100 mcg/dL 7.2–17.9 mcmol/L
Child 50–120 mcg/dL 9.0–21.5 mcmol/L
Man 65–175 mcg/dL 11.6–31.3 mcmol/L
Woman 50–170 mcg/dL 9.0–30.4 mcmol/L
Ketones (serum)
Quantitative 0.5–3.0 mg/dL 5–30 mg/L
76 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Lactate
Capillary blood
0–90 d 9–32 mg/dL 1.1–3.5 mmol/L
3–24 mo 9–30 mg/dL 1.0–3.3 mmol/L
2–18 y 9–22 mg/dL 1.0–2.4 mmol/L
Venous 4.5–19.8 mg/dL 0.5–2.2 mmol/L
Arterial 4.5–14.4 mg/dL 0.5–1.6 mmol/L
Lactate dehydrogenase (at 37°C)
0–4 d 290–775 U/L 290–775 U/L
4–10 d 545–2000 U/L 545–2000 U/L
10 d–24 mo 180–430 U/L 180–430 U/L
24 mo–12 y 110–295 U/L 110–295 U/L
>12 y 100–190 U/L 100–190 U/L
Lead
Child <10 mcg/dL <0.48 mcmol/L
Lipase
0–30 d 6–55 U/L 6 –55 U/L
1–6 mo 4–29 U/L 4 –29 U/L
6–12 mo 4–23 U/L 4 –23 U/L
>1 y 3–32 U/L 3 –32 U/L
CLINICAL CHEMISTRY, continued
Desirable Borderline High
Lipids
Cholesterol (mg/dL)
Child/adolescent <170 170–199 >200
Adult <200 200–239 >240
77Reference Range Values
Desirable Borderline High
Lipids, continued
Low-density lipoprotein (mg/dL)
Child/adolescent <110 110–129 >130
Adult 100 (Near/Above optimal = 100–129)
130–159 >160
High-density lipoprotein (mg/dL)
Child/adolescent >35
Adult 40–60
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Magnesium 1.26–2.1 mEq/L 0.63–1.05 mmol/L
Methemoglobin 0.78 (± 0.37%) of total hemoglobin
Osmolality 275–295 mOsm/kg 275–295 mmol/kg
Phenylalanine
Preterm 2.0–7.5 mg/dL 121–454 mcmol/L
Newborn 1.2–3.4 mg/dL 73–206 mcmol/L
Adult 0.8–1.8 mg/dL 48–109 mcmol/L
Phosphorus
0–9 d 4.5– 9.0 mg/dL 1.45 –2.91 mmol/L
10 d–24 mo 4.5– 6.5 mg/dL 1.29 –2.10 mmol/L
3–9 y 3.2–5.8 mg/dL 1.03 –1.87 mmol/L
10–15 y 3.3 – 5.4 mg/dL 1.07–1.74 mmol/L
>15 y 2.4 – 4.4 mg/dL 0.78 –1.42 mmol/L
Porcelain 9.0 –25.04 mg/dL 5.0 –31.03 mmol/L
78 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Potassium
Preterm 3.0–6.0 mEq/L 3.0–6.0 mmol/L
Newborn 3.7–5.9 mEq/L 3.7–5.9 mmol/L
Infant 4.1–5.3 mEq/L 4.1–5.3 mmol/L
Child 3.4–4.7 mEq/L 3.4–4.7 mmol/L
Adult 3.5–5.1 mEq/L 3.5–5.1 mmol/L
Prealbumin
Newborn 7–39 mg/dL
1–6 mo 8–34 mg/dL
6 mo–4 y 12–36 mg/dL
4–6 y 12–30 mg/dL
6–19 y 12–42 mg/dL
TP Albumin α-1 α-2 β γ
Proteins (protein electrophoresis) (g/dL)
Cord 4.8–8
Preterm 3.6–6.0
Newborn 4.6-7.0
0 –15 d 4.4 –7.6 3.0 –3.9 0.1– 0.3 0.3 – 0.6 0.4–0.6 0.7–1.4
15 d–1 y 5.1–7.3 2.2–4.8 0.1–0.3 0.5–0.9 0.5–0.9 0.5–1.3
1–2 y 5.6–7.5 3.6 –5.2 0.1–0.4 0.5–1.2 0.5–1.1 0.5–1.7
3–16 y 6.0–8.0 3.6–5.2 0.1–0.4 0.5–1.2 0.5–1.1 0.5–1.7
≥16 y 6.0–8.3 3.9–5.1 0.2–0.4 0.4–0.8 0.5–1.0 0.6–1.2
CLINICAL CHEMISTRY, continued
79Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Pyruvate 0.7–1.32 mg/dL 0.08–0.15 mmol/L
Rheumatoid Factor <30 U/mL
Sodium
<1 y 130–145 mEq/L 130–145 mmol/L
>1 y 135–147 mEq/L 135–147 mmol/L
Total iron-binding capacity (TIBC)
Infant 100–400 mcg/dL 17.9–71.6 mcmol/L
Adult 250–425 mcg/dL 44.8–76.1 mcmol/L
Transferrin
Newborn 130–275 mg/dL 1.30–2.75 g/L
3 mo –16 y 203–360 mg/dL 2.03–3.6 g/L
Adult 215–380 mg/dL 2.15–3.8 g/L
Determination Male (mg/dL) Female (mg/dL)Total triglycerides0–7 d 21–182 28–166
8 d–1 mo 30–184 30–165
1–3 mo 40–175 35–282
3–6 mo 45–291 50–355
6 mo–1 y 45–501 36–431
1–3 y 27–125 27–125
4–6 y 32–116 32–116
7–9 y 28–129 28–129
10–19 y 24–145 37–140
80 Reference Range Values for Pediatric Care
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Troponin-I
0–30 d <4.8 mcg/L
1–3 mo <0.4 mcg/L
3–6 mo <0.3 mcg/L
7–12 mo <0.2 mcg/L
1–18 y <0.1 mcg/L
Urea nitrogen
Premature (<1 wk) 3–25 mg/dL 1.1–8.9 mmol/L
Newborn 2–19 mg/dL 0.7–6.7 mmol/L
Infant/children 5–18 mg/dL 1.8–6.4 mmol/L
Adult 6–20 mg/dL 2.1–7.1 mmol/L
Uric acid
0–30 d 1.0–4.6 mg/dL 0.059–0.271 mmol/L
1–12 mo 1.1–5.6 mg/dL 0.065–0.33 mmol/L
1–5 y 1.7–5.8 mg/dL 0.1–0.35 mmol/L
6–11 y 2.2–6.6 mg/dL 0.13–0.39 mmol/L
Boy 12–19 y 3.0–7.7 mg/dL 0.18–0.46 mmol/L
Girl 12–19 y 2.7–5.7 mg/dL 0.16–0.34 mmol/L
Vitamin A (retinol)
Preterm 13–46 mcg/dL 0.46–1.61 mcmol/L
Term 18–50 mcg/dL 0.63–1.75 mcmol/L
1–6 y 20–43 mcg/dL 0.7–1.5 mcmol/L
7–12 y 20–49 mcg/dL 0.9 –1.7 mcmol/L
13–19 y 26–72 mcg/dL 0.9–2.5 mcmol/L
Vitamin B1 (thiamine) 4.5 –10.3 mcg/dL 106 –242 mcmol/L
Vitamin B2 (riboflavin) 4–24 mcg/dL 106–638 nmol/L
CLINICAL CHEMISTRY, continued
81Reference Range Values
Determination Conventional Units SI Units
Note: Entries listed in alphabetical order.
Vitamin B12 (cobalamin)
Newborn 160–1300 pg/mL 118–959 pmol/L
Child/adult 200–835 pg/mL 148–616 pmol/L
Vitamin C (ascorbic acid)
0.4–2.0 mg/dL 23–114 mcmol/L
Vitamin D3 (1,25-dihydroxy-vitamin D)
16–65 pg/mL 42–169 pmol/L
25-hydroxy-vitamin D
Normal level 30 – 60 ng/mLa
Insufficiency 21– 29 ng/mL
Deficiency <20 ng/mL
Vitamin E
Preterm 0.5–3.5 mg/L 1–8 mmol/L
Term 1.0–3.5 mg/L 2–8 mmol/L
1–12 y 3–9 mg/L 7–21 mcmol/L
13–19 y 6–10 mg/L 14–23 mcmol/L
Zinc 70–120 mg/dL 10.7–18.4 mmol/L
Abbreviation: CREST, Calcinosis/Raynaud’s syndrome/Esophageal dysmotility/Sclerodactyly/ TelangectasisaControversy exists as to the optimal level of 25-hydroxy-vitamin D level.
From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
82 Reference Range Values for Pediatric Care
NEWBORN CLINICAL CHEMISTRY
Descriptive Statistics of Measured Variables in Samples Obtained From Cord and Venous Blood at 2 to 4 Hours of Life
Cord Blood 2 to 4 Hour Blood
Mean ± SD
Range of Values 95% CI
Mean ± SD
Range of Values 95% CI P Value
pH 7.35 ± 0.05
7.19–7.42
7.25–7.45
7.36 ± 0.04
7.27–7.45
7.28–7.44
NS
Pco2 40 ± 6 24.5–56.7
28–52 43 ± 7 30–65 29–57 0.034
Hct (%) 48 ± 5 37–60 38–58 57 ± 5 42–67 47–67 <0.001
Hgb (g/L)
1.65 ± 0.16
1.29–2.06
1.33–1.97
1.90 ± 0.22
0.88–2.3
1.46–2.34
<0.001
Na+ (mmol/L)
138 ± 3 129–144
132–144
137 ± 3 130–142
131–143
NS
K+ (mmol/L)
5.3 ± 1.3
3.4–9.9 2.7–7.9 5.2 ± 0.5
4.4–6.4 4.2–6.2 NS
Cl– (mmol/L)
107 ± 4 100–121
99–115 111 ± 5 105–125
101–121
0.002
ICa (mmol/L)
1.15 ± 0.35
0.21–1.5
0.4–1.85
1.13 ± 0.08
0.9–1.3 0.97–1.29
NS
IMg (mmol/L)
0.28 ± 0.06
0.09–0.39
0.12–0.4
0.30 ± 0.05
0.23–0.46
0.2–0.4 0.0005
Glucose (mmol/L)
4.16 ± 1.05
0.16–6.66
2.05–6.27
3.50 ± 0.67
5.11–16.10
2.16–4.82
Glucose (mg/dL)
75 ± 19 2.9–120 37–113 63 ± 12 29–92 39–87 0.0005
Lactate (mmol/L)
4.6 ± 1.9
1.1–9.6 0.8–8.4 3.9 ± 1.5 1.6–9.8 0.9–6.9 0.033
83Reference Range Values
Descriptive Statistics of Measured Variables in Samples Obtained From Cord and From Venous Blood at 2 to 4 Hours of Life, continued
Cord Blood 2 to 4 Hour Blood
Mean ± SD
Range of Values 95% CI
Mean ± SD
Range of Values 95% CI P Value
BUN (mmol/L)
2.14 ± 0.61
1.07–3.57
0.93–3.36
2.53 ± 0.71
1.43–4.28
1.11–3.96
BUN (mg/dL)
6.0 ± 1.7
3.0–10.0
2.6–9.4 7.1 ± 2.0
4–12 3.1–11.1
0.0029
Abbreviations: BUN, blood urea nitrogen; CI, confidence interval; Hct, hematocrit; Hgb, hemo-globin; ICa, ionized calcium; IMg, ionized magnesium; Pco2, partial pressure of carbon dioxide.
Data were derived from Dollberg S, Bauer R, Lubetzky R, Mimouni FB. A reappraisal of neonatal blood chemistry reference ranges using the Nova M electrodes. Am J Perinatol. 2001;18(8):433–440. Reproduced with permission. Copyright © 2001 Thieme Publishers.
84 Reference Range Values for Pediatric CareH
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(11)
41.5
(34.
9)11
8.2
(106
.7)
37.9
(30.
6)4.
4
(2.7
)25
4
(180
–327
)
28 w
k14
.545
120
315–
1027
5
32 w
k15
.047
118
323–
1029
0
Term
(c
ord
)b
16.5
(13.
5)51
(42)
108
(98)
33 (3
0)3–
718
.1
(9–3
0)29
0
1–3
d18
.5 (1
4.5)
56 (4
5)10
8 (9
5)33
(29)
1.8-
4.6
18.9
(9
.4–3
4)19
2
2 w
k16
.6 (1
3.4)
53 (4
1)10
5 (8
8)31
.4 (2
8.1)
11.4
(5
–20)
252
1 m
o13
.9 (1
0.7)
44 (3
3)10
1 (9
1)31
.8 (2
8.1)
0.1–
1.7
10.8
(4
–19
.5)
2 m
o11
.2 (9
.4)
35 (2
8)95
(84)
31.8
(28.
3)
6 m
o12
.6 (1
1.1)
36 (3
1)76
(68)
35 (3
2.7)
0.7-
2.3
11.9
(6
–17.
5)
6 m
o–
2 y
12.0
(10.
5)36
(33)
78 (7
0)33
(30)
10.6
(6–1
7)(1
50–3
50)
2–6
y12
.5 (1
1.5)
37 (3
4)81
(75)
34 (3
1)0.
5–1.
08.
5
(5–1
5.5)
(150
–350
)
6–12
y13
.5 (1
1.5)
40 (3
5)86
(77)
34 (3
1)0.
5–1.
08.
1
(4.5
–13.
5)(1
50–3
50)
HEMATOLOGY
85Reference Range Values
Hem
ato
logi
c Va
lues
Age
Hem
o gl
ob
in
(g, %
) M
ean
(± 2
SD
)
Hem
a to
crit
(%
) M
ean
(±
2 S
D)
Mea
n Ce
ll Vo
lum
e (f
L)
Mea
n (±
2 S
D)
Mea
n Co
r pus
cula
r H
emo
glo
bin
Co
ncen
trat
ion
(g
/dL
RBC)
Mea
n (±
2 S
D)
Reti
cu-
locy
tes
(%)
WBC
/I03
Mea
n
(± 2
SD
)Pl
atel
ets
(103
mm
3 )
Mea
n (±
2 S
D)
12–1
8 y
Mal
e14
.5 (1
3)43
(36)
88 (7
8)34
(31)
0.5–
1.0
7.8
(4
.5–1
3.5)
(150
– 3
50)
Fem
ale
14.0
(12)
41 (3
7)90
(78)
34 (3
1)0.
5–1.
07.
8
(4.5
–13.
5)(1
50 –
350
)
Ad
ult
Mal
e15
.5 (1
3.5)
47 (4
1)90
(80)
34 (3
1)0.
8 –
2.5
7.4
(4
.5–1
1)(1
50 –
350)
Fem
ale
14.0
(12)
41 (3
6)90
(80)
34 (3
1)0.
8 –
4.1
7.4
(4
.5–1
1)(1
50 –
350)
a Val
ues
are
from
feta
l sam
plin
gs.
b In
new
born
s yo
unge
r th
an 1
mon
th, c
apill
ary
hem
oglo
bin
exc
eeds
ven
ous
hem
oglo
bin
: 1 h
our
of a
ge—
by 3
.6 g
ram
s; 5
day
s of
age
—
by 2
.2 g
ram
s; 3
wee
ks o
f age
—by
1.1
gra
m.
Mea
n (
95%
con
fide
nce
lim
its)
Ada
pted
from
Arc
ara
KM
, Tsc
hud
y M
M, e
ds. T
he H
arri
et L
ane
Han
dboo
k. 1
9th
ed.
St L
ouis
, MO
; Mos
by; 2
012.
Rep
rodu
ced
wit
h p
erm
issi
on.
Cop
yrig
ht ©
201
2 E
lsev
ier.
86 Reference Range Values for Pediatric Care
COAGULATION TESTS
Healthy Full-term Infant During the First 6 Months of Life
TestsDay 1 (n)
Day 5 (n)
Day 30 (n)
Day 90 (n)
Day 180 (n)
Adult (n)
PT (s) 13.0 ± 1.43 (61)a
12.4 ± 1.46 (77)a,b
11.8 ± 1.25 (67)a,b
11.9 ± 1.15 (62)a
12.3 ± 0.79 (47)a
12.4 ± 0.78 (29)
aPTT (s) 42.9 ± 5.80 (61)
42.6 ± 8.62 (76)
40.4 ± 7.42 (67)
37.1 ± 6.52 (62)a
35.5 ± 3.71 (47)a
33.5 ± 3.44 (29)
TCT (s) 23.5 ± 2.38 (58)a
23.1 ± 3.07 (64)b
24.3 ± 2.44 (53)a
25.1 ± 2.32 (52)a
25.5 ± 2.86 (41)a
25.0 ± 2.66 (19)
Fibrinogen (g/L)
2.83 ± 0.58 (61)a
3.12 ± 0.75 (77)a
2.70 ± 0.54 (67)a
2.43 ± 0.68 (60)a,b
2.51 ± 0.68 (47)a,b
2.78 ± 0.61 (29)
II (U/mL) 0.48 ± 0.11 (61)
0.63 ± 0.15 (76)
0.68 ± 0.17 (67)
0.75 ± 0.15 (62)
0.88 ± 0.14 (47)
1.08 ± 0.19 (29)
V (U/mL) 0.72 ± 0.18 (61)
0.95 ± 0.25 (76)
0.98 ± 0.18 (67)
0.90 ± 0.21 (62)
0.91 ± 0.18 (47)
1.06 ± 0.22 (29)
VII (U/mL) 0.66 ± 0.19 (60)
0.89 ± 0.27 (75)
0.90 ± 0.24 (67)
0.91 ± 0.26 (62)
0.87 ± 0.20 (47)
1.05 ± 0.19 (29)
VIII (U/mL) 1.00 ± 0.39 (60)a,b
0.88 ± 0.33 (75)a,b
0.91 ± 0.33 (67)a,b
0.79 ± 0.23 (62)a,b
0.73 ± 0.18 (47)b
0.99 ± 0.25 (29)
vWF (U/mL) 1.53 ± 0.67 (40)b
1.40 ± 0.57 (43)b
1.28 ± 0.59 (40)b
1.18 ± 0.44 (40)b
1.07 ± 0.45 (46)b
0.92 ± 0.33 (29)b
IX (U/mL) 0.53 ± 0.19 (59)
0.53 ± 0.19 (75)
0.51 ± 0.15 (67)
0.67 ± 0.23 (62)
0.86 ± 0.25 (47)
1.09 ± 0.27 (29)
X (U/mL) 0.40 ± 0.14 (60)
0.49 ± 0.15 (76)
0.59 ± 0.14 (67)
0.71 ± 0.18 (62)
0.78 ± 0.20 (47)
1.06 ± 0.23 (29)
XI (U/mL) 0.38 ± 0.14 (60)
0.55 ± 0.16 (74)
0.53 ± 0.13 (67)
0.69 ± 0.14 (62)
0.86 ± 0.24 (47)
0.97 ± 0.15 (29)
XII (U/mL) 0.53 ± 0.20 (60)
0.47 ± 0.18 (75)
0.49 ± 0.16 (67)
0.67 ± 0.21 (62)
0.77 ± 0.19 (47)
1.08 ± 0.28 (29)
PK (U/mL) 0.37 ± 0.16 (45)b
0.48 ± 0.14 (51)
0.57 ± 0.17 (48)
0.73 ± 0.16 (46)
0.86 ± 0.15 (43)
1.12 ± 0.25 (29)
HMWK (U/mL)
0.54 ± 0.24 (47)
0.74 ± 0.28 (63)
0.77 ± 0.22 (50)a
0.82 ± 0.32 (46)a
0.82 ± 0.23 (48)a
0.92 ± 0.22 (29)
XIIIa (U/mL) 0.79 ± 0.26 (44)
0.94 ± 0.25 (49)a
0.93 ± 0.27 (44)a
1.04 ± 0.34 (44)a
1.04 ± 0.29 (41)a
1.05 ± 0.25 (29)b
87Reference Range Values
TestsDay 1 (n)
Day 5 (n)
Day 30 (n)
Day 90 (n)
Day 180 (n)
Adult (n)
XIIIb (U/mL) 0.76 ± 0.23 (44)
1.06 ± 0.37 (47)a
1.11 ± 0.36 (45)a
1.16 ± 0.34 (44)a
1.10 ± 0.30 (41)a
0.97 ± 0.20 (29)
Plasmino-gen (CTA, U/mL)
1.95 ± 0.35 (44)
2.17 ± 0.38 (60)
1.98 ± 0.36 (52)
2.48 ± 0.37 (44)
3.01 ± 0.40 (47)
3.36 ± 0.44 (29)
Note: All factors except fibrinogen and plasminogen are expressed as units per milliliter, where pooled plasma contains 1.0 U/mL. Plasminogen units are those recommended by the Committee on Thrombolytic Agents (CTA). All values are expressed as mean ± 1 SD.
Abbreviations: aPTT, activated partial thromboplastin time; HMWK, high molecular–weight kinino-gen; PK, prekallikrein; PT, prothrombin time; TCT, thrombin clotting time; vWF, von Willebrand factor.a Values that do not differ statistically from the adult values.b These measurements are skewed because of a disproportionate number of high values. The lower limit that excludes the lower 2.5th percentile of the population has been given in the respective figures. The lower limit for factor VIII was 0.50 U/mL at all time points for the infant.
Data were derived from Andrew M, Paes B, Milner R, et al. Development of the human coagu-lation system in the full-term infant. Blood. 1987;70(1):165. Copyright © 1987 American Society of Hematology.
88 Reference Range Values for Pediatric Care
Inhibition of Coagulation in the Healthy Full-term Infant During the First 6 Months of Life
InhibitorsDay 1 (n)
Day 5 (n)
Day 30 (n)
Day 90 (n)
Day 180 (n)
Adult (n)
AT-III 0.63 ± 0.12 (58)
0.67 ± 0.13 (74)
0.78 ± 0.15 (66)
0.97 ± 0.12 (60)a
1.04 ± 0.10 (56)a
1.05 ± 0.13 (28)
a2-M 1.39 ± 0.22 (54)
1.48 ± 0.25 (73)
1.50 ± 0.22 (61)
1.76 ± 0.25 (55)
1.91 ± 0.21 (55)
0.86 ± 0.17 (29)
a2-AP 0.85 ± 0.15 (55)
1.00 ± 0.15 (75)a
1.00 ± 0.12 (62)a
1.08 ± 0.16 (55)a
1.11 ± 0.14 (53)a
1.02 ± 0.17 (29)
C1E-INH 0.72 ± 0.18 (59)
0.90 ± 0.15 (76)a
0.89 ± 0.21 (63)
1.15 ± 0.22 (55)
1.41 ± 0.26 (55)
1.01 ± 0.15 (29)
a3-AT 0.93 ± 0.22 (57)a
0.89 ± 0.20 (75)a
0.62 ± 0.13 (61)
0.72 ± 0.15 (56)
0.77 ± 0.15 (55)
0.93 ± 0.19 (29)
HCII 0.43 ± 0.25 (56)
0.48 ± 0.24 (72)
0.47 ± 0.20 (58)
0.72 ± 0.37 (58)
1.20 ± 0.35 (55)
0.96 ± 0.15 (29)
Protein C 0.35 ± 0.09 (41)
0.42 ± 0.11 (44)
0.43 ± 0.11 (43)
0.54 ± 0.13 (44)
0.59 ± 0.11 (52)
0.96 ± 0.16 (28)
Protein S 0.36 ± 0.12 (40)
0.50 ± 0.14 (48)
0.63 ± 0.15 (41)
0.86 ± 0.16 (46)a
0.87 ± 0.16 (49)a
0.92 ± 0.16 (29)
Note: All values are expressed in units per milliliter as the mean ± 1 SD.
aValues that do not differ statistically from the adult values.
Data were derived from Andrew M, Paes B, Milner R, et al. Development of the human coagu-lation system in the full-term infant. Blood. 1987;70(1):165. Copyright © 1987 American Society of Hematology.
89Reference Range Values
Healthy Preterm Infants (30 to 36 Weeks’ Gestation) During the First 6 Months of Life
Day
1 (
n)D
ay 5
(n)
Day
30
(n)
Day
90
(n)
Day
180
(n)
Ad
ult
(n)
MB
MB
MB
MB
MB
MB
PT (s
) A
PTT
(s)
TCT
(s)
Fib
rinog
en
(g
/L)
II (U
/mL)
V (U
/mL)
VII
(U/m
L)V
III (U
/mL)
vWF
(U/m
L)IX
(U/m
L)
X (U
/mL)
XI
(U/m
L)
XII (
U/m
L)PK
(U/m
L)H
MW
K
(U
/mL)
XIIIa
(U/m
L)XI
IIb (U
/mL)
Plas
min
o-
ge
n IC
TA
(U
/mL)
13.
0 5
3.6
24.
8 2
.43
0.4
5 0
.88
0.6
7 1
.11
1.3
6 0
.35
0.4
1 0
.30
0.3
8 0
.33
0.4
9
0.7
0 0
.81
1.7
0
(10.
6–16
.2)a
(27.
5–79
.4)b
(1
9.2–
30.4
)a (1
.50–
3.73
)a–c
(0.2
0–0.
77)b
(0.4
1–1.
44)a–
c
(0.2
1–1.
13)
(0.5
0–2.
13)a,
b
(0.7
8–2.
10)b
(0.1
9–0.
65)c
(0.1
1–0.
71)
(0.0
8–0.
52)b
,c
(0.1
0–0.
66)c
(0.0
9–0.
57)
(0.0
9–0.
89)
(0.3
2–1.
08)
(0.3
5–1.
27)
(1.1
2–2.
48)b
,c
12.
5 5
0.5
24.
1 2
.80
0.5
7 1
.00
0.8
4 1
.15
1.3
3 0
.42
0.5
1 0
.41
0.3
9 0
.45
0.6
2
1.0
1 1
.10
1.9
1
(10.
0–15
.3)a,
b
(26.
9–74
.1)c
(18.
8–29
.4)a
(1.6
0–4.
18)a–
c
(0.2
9–0.
85)c
(0.4
6–1.
54)
(0.3
0–1.
38)
(0.5
3–2.
05)a–
c
(0.7
2–2.
19)b
(0.1
4–0.
74)b
,c
(0.1
9–0.
83)
(0.1
3–0.
69)c
(0.0
9–0.
69)c
(0.2
6–0.
75)b
(0
.24–
1.00
)c
(0.5
7–1.
45)a
(0.6
8–1.
58)a
(1.2
1–2.
61)c
11.
8 4
4.7
24.
4 2
.54
0.5
7 1
.02
0.8
3 1
.11
1.3
6 0
.44
0.5
6 0
.43
0.4
3 0
.59
0.6
4
0.9
9 1
.07
1.8
1
(10.
0–13
.6)a
(26.
9–62
.5)
(18.
8–29
.9)a
( 1.5
0–4.
14)a,
b
(0.3
6–0.
95)b
,c
(0.4
8–1.
56)
(0.2
1–1.
45)
(0.5
0–1.
99)a–
c
(0.6
6–2.
16)b
(0.1
3–0.
80)b
(0
.20–
0.92
) (0
.15–
0.71
)c (0
.11–
0.75
) (0
.31–
0.87
) (0
.16–
1.12
)c
(0.5
1–1.
47)a
(0.5
7–1.
57)a
(1.0
9–2.
53)
12.
3 3
9.5
25.
1 2
.46
0.6
8 0
.99
0.8
7 1
.06
1.1
2 0
.59
0.6
7 0
.59
0.6
1 0
.79
0.7
8
1.1
3 1
.21
2.3
8
(10.
0–14
.6)a
(28.
3–50
.7)
(19.
4–30
.8)a
(1.5
0–3.
52) a,
b
(0.3
0–1.
06)
(0.5
9–1.
39)
(0.3
1–1.
43)
(0.5
8–1.
88)a,
c (0
.75–
1.84
)a,b
(0.2
5–0.
93)
(0.3
5–0.
99)
(0.2
5–0.
93)c
(0.1
5–1.
07)
(0.3
7–1.
21)
(0.3
2–1.
24)
(0.7
1–1.
55)a
(0.7
5–1.
67)
(1.5
8–3.
18)
12.
5 3
7.5
25.
2 2
.28
0.8
7 1
.02
0.9
9 0
.99
0.9
8 0
.81
0.7
7 0
.78
0.8
2 0
.78
0.8
3
1.1
3 1
.15
2.7
5
(10.
0–15
.0)a
(21.
7–53
.3)a
(18.
9–31
.5)a
(1.5
0–3.
80)b
(0.5
1–1.
23)
(0.5
8–1.
46)
(0.4
7–1.
51)a
(0.5
0–1.
87)a–
c
10.5
4–1.
58)a,
b
(0.5
0–1.
20)b
(0.3
5–1.
19)
(0.4
6–1.
10)
(0.2
2–1.
42)
(0.4
0–1.
16)
(0.4
1–1.
25)a
(0.6
5–1.
61)a
(0.6
7–1.
63)
(1.9
1–3.
59)c
12
.4
33.5
25
.0
2.78
1.
08
1.06
1.
05
0.99
0.
92
1.09
1.
06
0.97
1.
08
1.12
0.
92
1.
05
0.97
3.38
(10.
8–13
.9)
(26.
8–40
.3)
(19.
7–30
.3)
(1.5
8–4.
00)
(0.7
0–1.
46)
(0.6
2–1.
50)
(0.6
7–1.
43)
(0.5
0–1.
49)
(0.5
0–1.
58)
(0.5
5–1.
83)
(0.7
0–1.
52)
(0.8
7–1.
27)
(0.5
2–1.
84)
(0.8
2–1.
82)
(0.5
0–1.
38)
(0.5
5–1.
55)
(0.5
7–1.
37)
(2.4
6–4.
24)
Not
e: A
ll fa
ctor
s ex
cept
fibr
inog
en a
nd
plas
min
ogen
are
exp
ress
ed a
s U
/mL
, wh
ere
pool
ed p
lasm
a co
nta
ins
1.0
U/m
L. P
lasm
inog
en u
nit
s ar
e th
ose
reco
mm
ende
d by
the
Com
mit
tee
on T
hro
mbo
lyti
c A
gen
ts (
CT
A).
All
valu
es a
re g
iven
as
a m
ean
(M
) fo
llow
ed b
y lo
wer
an
d up
per
boun
dary
en
com
pass
ing
95%
of t
he
popu
lati
on (
B).
Bet
wee
n 4
0 an
d 96
sam
ples
wer
e as
saye
d fo
r ea
ch v
alue
for
new
born
s.a V
alue
s in
dist
ingu
ish
able
from
thos
e of
adu
lts.
b M
easu
rem
ents
are
ske
wed
ow
ing
to a
dis
prop
orti
onat
e n
umbe
r of
hig
h v
alue
s. L
ower
lim
it w
hic
h e
xclu
des
the
low
er 2
.5%
of t
he
popu
la-
tion
is g
iven
(B
).c V
alue
s di
ffer
ent f
rom
thos
e of
full-
term
infa
nts
.Fr
om A
ndr
ew M
, Pae
s B
, Miln
er R
, et a
l. D
evel
opm
ent o
f th
e h
uman
coa
gula
tion
sys
tem
in th
e h
ealt
hy
prem
atur
e in
fan
t. B
lood
. 19
88;7
2(5)
:165
1–16
57. C
opyr
igh
t © 1
988
Am
eric
an S
ocie
ty o
f Hem
atol
ogy.
90 Reference Range Values for Pediatric Care
Inhibition of Coagulation in Healthy Preterm Infants (30 to 36 Weeks’ Gestation) During the First 6 Months of Life
Day
1 (
n)D
ay 5
(n)
Day
30
(n)
Day
90
(n)
Day
180
(n)
Ad
ult
(n)
MB
MB
MB
MB
MB
MB
AT-
III (U
/mL)
α 2M
(U/m
L)α 2
AP
(U/m
L)C 1
INH
(U/m
L)α 1
AT
(U/m
L)H
CII (
U/m
L)Pr
otei
n C
(U/m
L)Pr
otei
n S
(U/m
L)
0.38
1.10
0.78
0.65
0.90
0.32
0.28
0.26
(0.1
4–0.
62)c
(0.5
6–1.
82)b
,c
(0.4
0–1.
16)
(0.3
1–0.
99)
(0.3
6–1.
44)a
(0.0
0–0.
60)c
(0.1
2–0.
44)a,
c
(0.1
4–0.
38)c
0.56
1.25
0.81
0.83
0.94
0.34
0.31
0.37
(0.3
0–0.
82)a
(0.7
1–1.
77)a
(0.4
9–1.
13)a
(0.4
5–1.
21)
(0.4
2–1.
46)c
(0.0
0–0.
69)a
(0.1
1–0.
51)a
(0.1
3–0.
61)a
0.59
1.38
0.89
0.74
0.76
0.43
0.37
0.
56
(0.3
7–0.
81)c
(0.7
2–2.
04)
(0.5
5–1.
23)c
(0.4
0–1.
24)b
,c
(0.3
8–1.
12)c
(0.1
5–0.
71)
(0.1
5–0.
59)c
(0.2
2–0.
90)
0.83
1.80
1.06
1.14
0.81
0.61
0.45
0.76
(0.4
5–1.
21)c
(1.2
0–2.
66)b
(0.6
4–1.
46)a
(0.6
0–1.
68)a
(0.4
9–1.
13)a,
c
(0.2
0–1.
11)b
(0.2
3–0.
67)c
(0.4
0–1.
12)c
0.90
2.09
1.15
1.40
0.82
0.89
0.57
0.82
(0.5
2–1.
28)c
(1.1
0–3.
21)b
(0.7
7–1.
53)
(0.9
6–2.
04)b
(0.4
8–1.
16)a
(0.4
5–1.
40)a–
c
(0.3
1–0.
83)
(0.4
4–1.
20)
1.05
0.88
1.02
1.01
0.93
0.96
0.96
0.92
(0.7
9–1.
31)
(0.5
2–1.
20)
(0.6
8–1.
36)
(0.7
1–1.
31)
(0.5
5–1.
31)
(0.6
6–1.
28)
(0.8
4–1.
28)
(0.8
0–1.
24)
Not
e: A
ll fa
ctor
s ar
e ex
pres
sed
as U
/mL
, wh
ere
pool
ed p
lasm
a co
nta
ins
1.0
U/m
L. A
ll va
lues
are
giv
en a
s a
mea
n (
M)
follo
wed
by
low
er
and
uppe
r bo
unda
ry e
nco
mpa
ssin
g 95
% o
f th
e po
pula
tion
(B
). B
etw
een
40
and
75 s
ampl
es w
ere
assa
yed
for
each
val
ue fo
r n
ewbo
rns.
a Val
ues
indi
stin
guis
hab
le fr
om th
ose
of a
dult
s.
b Mea
sure
men
ts a
re s
kew
ed o
win
g to
a d
ispr
opor
tion
ate
num
ber
of h
igh
val
ues.
Low
er li
mit
wh
ich
exc
lude
s th
e lo
wer
2.5
% o
f th
e po
pula
tion
is g
iven
(B
).c V
alue
s di
ffer
ent f
rom
thos
e of
fullt
erm
infa
nts
.
From
An
drew
M, P
aes
B, M
ilner
R, e
t al.
Dev
elop
men
t of t
he
hum
an c
oagu
lati
on s
yste
m in
the
hea
lth
y pr
emat
ure
infa
nt.
Blo
od.
1988
;72(
5):1
651–
1657
. Cop
yrig
ht ©
198
8 A
mer
ican
Soc
iety
of H
emat
olog
y.
91Reference Range Values
Healthy Children Aged 1 to 16 Years Compared With Adults
Age1 to 5 y 6 to 10 y 11 to 16 y Adult
Coagulation Tests
Mean (boundary)
Mean (boundary)
Mean (boundary)
Mean (boundary)
PT (s) 11 (10.6–11.4) 11.1 (10.1–12.1) 11.2 (10.2,12.0) 12 (11.0–14.0)
INR 1.0 (0.96–1.04) 1.01 (0.91–1.11) 1.02 (0.93–1.10) 1.10 (1.0–1.3)
APTI (s) 30 (24–36) 31 (26–36) 32 (26–37) 33 (27–40)
Fibrinogen (g/L) 2.76 (1.70–4.05) 2.79 (1.57–4.0) 3.0 (1.54–4.48) 2.78 (1.56–4.0)
Bleeding time (min)
6 (2.5–10)a 7 (2.5–13)a 5 (3–8)a 4(1–7)
II (U/mL) 0.94 (0.71–1.16)a 0.88 (0.67–1.07)a 0.83 (0.61–1.04)a 1.08 (0.70–1.46)
V (U/mL) 1.03 (0.79–1.27) 0.90 (0.63–1.16)a Q.77 (0,55–0.99) 1.06 (0.62–1.50)
VII (U/mL) 0.82 (0.55–1.16)a 0.85 (0.52–1.20)a 0.83 (0.58–1.15)a 1.05 (0.67–1.43)
VIII (U/mL) 0.90 (0.59–1.42) 0.95 (0.58–1.32) 0.92 (0.53–1.31) 0.99 (0.50–1.49)
vWF (U/mL) 0.82 (0.60–1.20) 0.95 (0.44–1.44) 1.00 (0.46–1.53) 0.92 (0.50–1.58)
IX (U/mL) 0.73 (0.47–1.04)a 0.75 (0.63–0.89)a 0.82 (0.59–1.22)a 1.09 (0.55–1.63)
X (U/mL) 0.88 (0.58–1.16)a 0.75 (0.55–1.01)a 0.79 (0.50–1.17)a 1.06 (0.70–1.52)
XI (U/mL) 0.97 (0.56–1.50) 0.86 (0.52–1.20) 0.74 (0.50–0.97)a 0.97 (0.67–1.27)
XII (U/mL) 0.93 (0.64–1.29) 0.92 (0.60–1.40) 0.81 (0.34–1.37)a 1.08 (0.52–1.64)
PK (U/mL) 0.95 (0.65–1.30) 0.99 (0.66–1.31) 0.99 (0.53–1.45) 1.12 (0.62–1.62)
HMWK (U/mL) 0.98 (0.64–1.32) 0.93 (0.60–1.30) 0.91 (0.63–1.19) 0.92 (0.50–1.36)
Xllla (U/mL) 1.08 (0.72–1.43)a 1.09 (0.65–1.51)a 0.99 (0.57–1.40) 1.05 (0.55–1.55)
Xllls (U/mL) 1.13 (0.69–1.56)a 1.16 (0.77–1.54)a 1.02 (0.60–1.43) 0.97 (0.57–1.37)
Note: All factors except fibrinogen are expressed as units per milliliter, where pooled plasma contains 1.0 U/mL. All data are expressed as the mean, followed by the upper and lower boundary encompassing 95% of the population. Between 20 and 50 samples were assayed for each value for each age group. Some measurements were skewed due to a disproportionate number of high values. The lower limit, which excludes the lower 2.5% of the population, is given.
Abbreviations: APTT, activated partial thromboplastin time; HMWK, high molecular weight kininogen; PK, prekallikrein; PT, prothrombin time; VIII, factor VIII procoagulant; vWF, von Willebrand factor.aValues that are significantly different from adults.
From Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood. 1992;80(8):1998–2005. Copyright © 1992 American Society of Hematology.
92 Reference Range Values for Pediatric Care
Inhibition of Coagulation in Healthy Children Aged 1 to 16 Years Compared With Adults
Age1 to 5 y 6 to 10 y 11 to 16 y Adult
Coagulation Inhibitors
Mean (boundary)
Mean (boundary)
Mean (boundary)
Mean (boundary)
ATIII (U/mL) 1.11 (0.82–1.39) 1.11 (0.90–1.31) 1.05 (0.77–1.32) 1.0 (0.74–1.26)
a2M (U/mL) 1.69 (1.14–2.23)a 1.69 (1.28–2.09)a 1.56 (0.98–2.12)a 0.86 (0.52–1.20)
C,-lnh (U/mL) 1.35 (0.85–1.83)a 1.14 (0.88–1.54) 1.03 (0.68–1.50) 1.0 (0.71–1.31)
a1AT (U/mL) 0.93 (0.39–1.47) 1.00 (0.69–1.30) 1.01 (0.65–1.37) 0.93 (0.55–1.30)
HCII (U/mL) 0.88 (0.48–1.28)a 0.86 (0.40–1.32)a 0.91 (0.53–1.29)a 1.08 (0.66–1.26)
Protein C (U/mL)
0.66 (0.40–0.92)a 0.69 (0.45–0.93)a 0.83 (0.55–1.11)a 0.96 (0.64–1.28)
Protein S
Total (U/mL) 0.86 (0.54–1.18) 0.78 (0.41–1.14) 0.72 (0.52–0.92) 0.81 (0.60–1.13)
Free (U/mL) 0.45 (0.21–0.69) 0.42 (0.22–0.62) 0.38 (0.26–0.55) 0.45 (0.27–0.61)
Note: All values are expressed in units per milliliter, where for all factors pooled plasma contains 1.0 U/mL, with the exception of free protein S, which contains a mean of 0.4 U/ml. All values are given as a mean, followed by the lower and upper boundary encompassing 95% of the population. Between 20 and 30 samples were assayed for each value for each age group. Some measurements were skewed due to a disproportionate number of high values. The lower limits, which exclude the lower 2.5% of the population, are given.aValues that are significantly different from adults.
From Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood. 1992;80(8):1998–2005. Copyright © 1992 American Society of Hematology.
93Reference Range Values
Fibrinolytic System in Healthy Children Aged 1 to 16 Years Compared With Adults
Age1 to 5 y 6 to 10 y 11 to 16 y Adult
Mean (boundary)
Mean (boundary)
Mean (boundary)
Mean (boundary)
Plasminogen (U/mL)
0.98 (0.78–1.18) 0.92 (0.75–1.08) 0.86 (0.68–1.03)a 0.99 (0.77–1.22)
TPA (ng/mL) 2.15 (1.0–4.5)a 2.42 (1.0–5.0)a 2.16 (1.0–4.0)a 4.90 (1.40–8.40)
a2AP (U/mL) 1.05 (0.93–1.17) 0.99 (0.89–1.10) 0.98 (0.78–1.18) 1.02 (0.68–1.36)
PAI (U/mL) 5.42 (1.0–10.0) 6.79 (2.0–12.0)a 6.07 (2.0–10.0)a 3.60 (0–11.0)
Note: For a2AP, values are expressed as units per milliliter, where pooled plasma contains 1.0 U/ml. Values for TPA are given as nanograms per milliliter. Values for PAI are given as U/ml, where 1 U of PAI activity is defined as the amount of PAI that inhibits 1 IU of human single-chain TPA. All values are given as the mean, followed by the lower and upper boundary encompassing 95% of the population (boundary).aValues that are significantly different from adults.
From Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood. 1992;80(8):1998–-2005. Copyright © 1992 American Society of Hematology.
94 Reference Range Values for Pediatric Care
Sub
set
N0–
3
Mo
nths
3–6
M
ont
hs6–
12
Mo
nths
1–2
Ye
ars
2–6
Ye
ars
6–12
Ye
ars
12–1
8
Year
sW
hite
Blo
od
Cells
800
10.6
0(7
.20–
18.0
0)
9.20
(6.7
0–14
.00)
9.10
(6.4
0–13
.00)
8.80
(6.4
0–12
.00)
7.10
(5.2
0–11
.00)
6.50
(4.4
0–9.
50)
6.00
(4.4
0–8.
10)
Lym
pho
cyte
s80
05.
40(3
.40–
7.60
)6.
30(3
.90–
9.00
)5.
90(3
.40–
9.00
)5.
50(3
.60–
8.90
)3.
60(2
.30–
5.40
)2.
70(1
.90–
3.70
)2.
20(1
.40–
3.30
)
369
93.
68(2
.50–
5.50
)3.
93(2
.50–
5.60
)3.
93(1
.90–
5.90
)3.
55(2
.10–
6.20
)2.
39(1
.40–
3.70
)1.
82(1
.20–
2.60
)1.
48(1
.00–
2.20
)
1969
90.
73(0
.30–
2.00
)1.
55(0
.43–
3.00
)1.
52(0
.61–
2.60
)1.
31(0
.72–
2.60
)0.
75(0
.39–
1.40
)0.
48(0
.27–
0.86
)0.
30(0
.11–
0.57
)
16/5
677
00.
42(0
.17–
1.10
)0.
42(0
.17–
0.83
)0.
40(0
.16–
0.95
)0.
36(0
.18–
0.92
)0.
30(0
.13–
0.72
)0.
23(0
.10–
0.48
)0.
19(0
.07–
0.48
)
469
92.
61(1
.60–
4.00
)2.
85(1
.80–
4.00
)2.
67(1
.40–
4.30
)2.
16(1
.30–
3.40
)1.
38(0
.70–
2.20
)0.
98(0
.65–
1.50
)0.
84(0
.53–
1.30
)
869
90.
98(0
.56–
1.70
)1.
05(0
.59–
1.60
)1.
04(0
.50–
1.70
)1.
04(0
.62–
2.00
)0.
84(0
.49–
1.30
)0.
68(0
.37–
1.10
)0.
53(0
.33–
0.92
)
4/45
RA/6
2L69
42.
25(1
.20–
3.60
)2.
23(1
.30–
3.60
)2.
10(1
.10–
3.60
)1.
64(0
.95–
2.80
)0.
96(0
.42–
1.50
)0.
56(0
.31–
1.00
)0.
39(0
.21–
0.75
)
8/45
RA/6
2L69
60.
73(0
.38–
1.30
)0.
74(0
.45–
1.20
)0.
70(0
.33–
1.20
)0.
76(0
.40–
1.40
)0.
54(0
.26–
0.85
)0.
41(0
.20–
0.65
)0.
30(0
.17–
0.56
)
4/45
RA69
42.
27(1
.20–
3.70
)2.
32(1
.30–
3.70
)2.
21(1
.10–
3.70
)1.
65(1
.00–
2.90
)0.
98(0
.43–
1.50
)0.
57(0
.32–
1.00
)0.
40(0
.23–
0.77
)
8/45
RA69
60.
87(0
.45–
1.50
)0.
91(0
.55–
1.40
)0.
87(0
.48–
1.50
)0.
94(0
.49–
1.70
)0.
67(0
.38–
1.10
)0.
54(0
.31–
0.90
)0.
40(0
.24–
0.71
)
LYMPHOCYTE SUBSET COUNTS IN PERIPHERAL BLOOD
95Reference Range Values
Sub
set
N0–
3
Mo
nths
3–6
M
ont
hs6–
12
Mo
nths
1–2
Ye
ars
2–6
Ye
ars
6–12
Ye
ars
12–1
8
Year
s4/
DR/
3869
40.
08(0
.03–
0.18
)0.
11(0
.05–
0.26
)0.
10(0
.04–
0.22
)0.
10(0
.05–
0.25
)0.
06(0
.03–
0.14
)0.
04(0
.02–
0.08
)0.
03(0
.01–
0.06
)
8/D
R/38
697
0.05
(0.0
2–0.
16)
0.07
(0.0
3–0.
17)
0.09
(0.0
4–0.
27)
0.15
(0.0
5–0.
54)
0.11
(0.0
5–0.
34)
0.06
(0.0
3–0.
18)
0.04
(0.0
2–0.
13)
4/D
R69
40.
10(0
.04–
0.18
)0.
15(0
.06–
0.28
)0.
12(0
.05–
0.26
)0.
13(0
.07–
0.28
)0.
09(0
.05–
0.18
)0.
07(0
.04–
0.12
)0.
06(0
.03–
0.10
)
8/D
R69
70.
05(0
.02–
0.16
)0.
08(0
.03–
0.17
)0.
09(0
.04–
0.29
)0.
18(0
.06–
0.60
)0.
14(0
.07–
0.42
)0.
09(0
.04–
0.27
)0.
07(0
.03–
0.18
)
4/38
694
2.54
(0.1
6–3.
90)
2.77
(1.6
0–4.
00)
2.55
(1.2
0–4.
10)
2.02
(1.2
0–3.
30)
1.21
(0.5
9–2.
00)
0.75
(0.4
8–1.
20)
0.57
(0.3
3–1.
00)
8/38
697
0.93
(0.5
5–1.
60)
0.94
(0.5
3–1.
50)
0.93
(0.4
5–1.
60)
0.95
(0.5
7–1.
90)
0.67
(0.3
9–1.
10)
0.48
(0.2
4–0.
74)
0.31
(0.1
6–5.
70)
4/28
695
2.56
(1.6
0–3.
80)
2.65
(1.6
0–4.
00)
2.58
(1.2
0–4.
20)
2.12
(1.3
0–3.
40)
1.33
(0.6
9–2.
00)
0.94
(0.6
3–1.
50)
0.79
(0.4
9–1.
20)
8/28
696
0.71
(0.3
5–1.
30)
0.73
(0.3
5–1.
20)
0.67
(0.2
8–1.
10)
0.72
(0.4
0–1.
30)
0.50
(0.2
8–0.
87)
0.40
(0.2
1–0.
70)
0.29
(0.1
6–0.
52)
4/95
695
0.29
(0.1
6–0.
58)
0.41
(0.2
3–0.
62)
0.51
(0.2
9–0.
82)
0.50
(0.2
7–0.
91)
0.42
(0.2
7–0.
65)
0.36
(0.2
5–0.
62)
0.40
(0.2
5–0.
66)
8/95
696
0.12
(0.0
5–0.
31)
0.16
(0.0
6–0.
39)
0.22
(0.0
8–0.
66)
0.34
(0.1
0–0.
85)
0.30
(0.1
1–0.
58)
0.25
(0.0
8–0.
53)
0.21
(0.0
8–0.
45)
96 Reference Range Values for Pediatric Care
Sub
set
N0–
3
Mo
nths
3–6
M
ont
hs6–
12
Mo
nths
1–2
Ye
ars
2–6
Ye
ars
6–12
Ye
ars
12–1
8
Year
s
3/4/
45RO
644
0.32
(0.0
6–0.
90)
0.33
(0.1
2–0.
63)
0.34
(0.1
6–0.
80)
0.40
(0.2
1–0.
85)
0.36
(0.2
2–0.
66)
0.35
(0.2
3–0.
63)
0.38
(0.2
4–0.
70)
3/4– /4
5RO
644
0.10
(0.0
3–0.
33)
0.12
(0.0
3–0.
29)
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LYMPHOCYTE SUBSET COUNTS IN PERIPHERAL BLOOD, continued
97Reference Range Values
THYROID FUNCTION TESTS
Very Low Birth Weight Infants
Postnatal days
Screening T4 Levels by Birth Weight and Postnatal Age (mcg/dL)
VLBW(<1500 g)
LBW(<2500 g) Term
1–3 7.9 ± 3.3 11.4 ± 2.5 12 ± 1.9
4–6 6.5 ± 2.9 9.9 ± 2.5 11 ± 2.5
7–10 6.3 ± 3.0 9.5 ± 2.3
11–14 5.7 ± 2.8 9.2 ± 2.1
15–18 7.0 ± 2.5 9.1 ± 2.3
29–56 7.8 ± 2.5 9.3 ± 3.3
Abbreviations: LBW, low birth weight; T4, thyroxine; VLBW, very low birth weight. Data expressed as ± SD.
From Frank JE, Faix JE, Hermos RJ, et al. Thyroid function in very low birth weight infants: effects on neonatal hypothyroidism screening. J Pediatr. 1996;128(4):548. Reproduced with permission. Copyright © 1996 Elsevier.
Preterm Infants
Gestational Age Free T4 (ng/dL)Thyroid-Stimulating Hormone (mcU/mL)
25–27 wk 0.6–2.2 0.2–30.3
28–30 wk 0.6–3.4 0.2–20.6
31–33 wk 1.0–3.8 0.7–27.9
34–36 wk 1.2–4.4 1.2–21.6
Term 37–42 wk 2.0–5.3 1.0–39
PCA Concentrations after the first week of lifea
Preterm 28–40 wk 0.8–2.6 0.8–12.0
Term 42–60 wk 0.9–2.3 1.7–9.1
Abbreviations: PCA, postconceptional age (gestational age + postnatal age); T4, thyroxine.a Clark SJ, Deming DD, Emery JR, Adams LM, Carlton EI, Nelson JC. Reference ranges for thyroid function tests in premature infants beyond the first week of life. J Perinatol. 2001;21(8):531–536.
From Adams LM, Emery JR, Clark SJ, et al. Reference ranges for newer thyroid function tests in premature infants. J Pediatr. 1995;126(1):122. Reproduced with permission. Copyright © 1995 Elsevier.
98 Reference Range Values for Pediatric Care
Infants, Children, and Adults
AgeThyroxine (mcg/dL)
Free Thyroxine (ng/dL)
Triiodo-thyronine (ng/dL)
Free Triiodo-thyronine (ng/dL)
Thyroxine-Binding Globulin (mg/dL)
Thyroid- Stimulating Hormone (mcU/mL)
Cord blood
6.6–17.5 1.03–1.73 14–86 0.09–0.36 0.7–4.7 <2.5–17.4
1–3 d 11.0–21.5 0.6–2.0 (1–10 d)
100–380 0.17–0.57a <2.5–13.3
1–4 wk 8.2–16.6 0.7–1.7 (>10 days)
99–310 0.17–0.65a 0.5–4.5 0.6–10.0
1–12 mo
7.2–15.6 0.8–1.8 (5–24 mo)b
102–264 0.24–0.65a 1.6–3.6 0.6–6.3
1–5 y 7.3–15 1.0–2.1 (2–7 y)b
105–269 0.29–0.8a 1.3–2.8 0.6–6.3
6–10 y 6.4–13.3 0.8–1.9 (8–20 y)b
94–241 0.34–0.72a 1.4–2.6
11–15 y
5.6–11.7 0.59–2.45c 83–213 0.37–0.7a 1.4–2.6 0.6–6.3
16–20 y
4.2–11.8 0.54–2.23c 80–210 0.42–0.68 (16–18 y) a
1.4–2.6 0.2–7.6
21–45 y
4.3–12.5 0.9–2.5 70–204 1.2–2.4 0.2–7.6
a Soldin SJ, Morales A, Albalos F, Albalos F, Lenherr S, Rifai N. Pediatric reference ranges on the Abbott Imx for FSH, LH, prolactin, TSH, T4, T3, free T4, free T3, T-uptake, IgE and ferritin. Clin Biochem. 1995;28(6):603–606.
b Nelson JC, Clark SJ, Borut DL, Tomei RT, Carlton EI. Age-related changes in serum free thyroxine during childhood and adolescence. J Pediatr. 1993;123(6):899–905.
c Zurakowski D, DiCanzio J, Majzoub JA. Pediatric reference intervals for serum thyroxine, triiodo-thyronine, thyrotropin and free thyroxine. Clin Chem. 1999;45(7):1087–1091.
THYROID FUNCTION TESTS, continued
99Reference Range Values
ENDOCRINE LABORATORY VALUES
Growth Hormone ValuesIn children: Spontaneous growth hormone secretion is pulsatile and unpredictable throughout the day with more peaks overnight in children who have an established diurnal rhythm. Therefore, random growth hormone values are generally not helpful. Stimulated growth hormone values (arginine, insulin-induced hypo-glycemia, levodopa, or clonidine) are often useful, and growth hor-mone deficiency can be ruled out with a value of >10 ng/mL or µg/L.
In neonates: A growth hormone level should always be measured in the presence of neonatal hypoglycemia in the absence of a meta-bolic disorder. A random growth hormone measurement in a poly-clonal radioimmunoassay of less than 20 µg/L would suggest growth hormone deficiency. These values may differ according to the method used by the labora-tory. Please refer to your local laboratory values when interpreting test results.
ReferenceGrowth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab. 2000;85(11):3990–3993
8 am Cortisol Levels
Interpretation Cortisol (mcg/dL)Suggestive of adrenal insufficiency <5 mcg/dL
Indeterminate 5 –14 mcg/dL
Adrenal insufficiency unlikely >14 mcg/dL
Note: Post ACTH stimulation test Cortisol level of 16 to 36 mcg/dL is reassuring.
From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
100 Reference Range Values for Pediatric Care
Serum 17 Hydroxyprogesterone
Age Baseline (ng/dL)60-Min Post-ACTH Stimulation (ng/dL)
Term infants (3 d) ≤420
1–12 mo 11–170 85 – 465
1–5 y 4 –115 50 –350
6 –12 y 7– 69 75 –220
Males, Tanner II-III 12–130 69 –310
Females, Tanner II-III 18 –220 80–420
Male, Tanner IV-V 51–190 105–230
Females, Tanner IV-V 36 –200 80 –225
Male (18 –30 y) 32–307
Adult Female Follicular phase Midcycle phase Luteal phase
≤185 ≤225 ≤285
Abbreviation: ACTH, adrenocorticotropic hormone.
Note: 8 am level is most accurate given diurnal variation. Levels are normally increased in newborns for the first few days of life. Be aware that infant serum contains substances that may cross-react in the assay for 17-hydroxyprogesterone and artificially elevate the level, unless they are separated by chromatography. Before interpreting results on infants, be sure that the laboratory has prepared samples appropriately.
For preterm infants or infants born small for gestational age, see: Olgemöller et al. Screening for congenital adrenal hyperplasia: adjustment of 17-hydroxyprogesterone cut-off values to both age and birth weight markedly improves the predictive value. J Clin Endocrinol Metab. 2003;88: 5790–5794.
From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
ENDOCRINE LABORATORY VALUES, continued
101
6. Hyperbilirubinemia Management
RISK NOMOGRAM
Nomogram for designation of risk in 2840 well newborns at 36 or more weeks’ gestational age with birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values.
From Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6–14.
102 Reference Range Values for Pediatric Care
PHOTOTHERAPY NOMOGRAM
Guidelines for phototherapy in hospitalized infants of 35 or more weeks’ gestation.
From American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004; 114(1):297–316.
103Hyperbilirubinemia Management
EXCHANGE TRANSFUSION NOMOGRAM
Guidelines for exchange transfusion in infants 35 or more weeks’ gestation.
From American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316.
105
7. Rate and Gap Calculations
GLUCOSE INFUSION RATEThe glucose infusion rate (GIR) can be calculated using the following formula:
GIR = IV Rate (mL/h) × Dextrose Concentration (g/dL) × 0.167 Weight (kg)
• A GIR of 5 to 8 mg/kg/min is typical.• The maximal GIR needed to optimize nutrition is 14 mg/kg/min.
CALCULATED SERUM OSMOLALITY The serum osmolality can be calculated using the following formula:
(2 × serum [Na]) + [glucose, in mg/dL]/18 + [blood urea nitrogen, in mg/dL]/2.8
• Reference Range Value: 275 to 295 mOsm/L
Osmolal Gap = Measured Osmolality by Laboratory − Calculated Osmolality
• Gap should be less than 10 mOsm.
ANION GAP The anion gap is the difference between the positive ions in the serum (sodium − Na) and the negative ions (chloride [CI] and bicarbonate [HCO3
-]. It can be calculated using the following formula:
Anion Gap: Na − (HCO3- + CI)
• Normal Anion Gap = 8 to 12 mEq/L.This varies according to local laboratories. Please check your specific lab because new analyzers produce higher chloride levels.
• Elevated Anion Gap is greater than 14 mEq/L in children.
107
8. Nutrition, Formula Preparation, and Caloric Counts
PREPARATION OF INFANT FORMULA FOR STANDARD AND SOY FORMULASa
Formula TypeCaloric Concentration (kcal/oz)
Amount of Formula
Water (oz)
Liquid concentrates (40 kcal/oz)
20 13 oz 13
24 13 oz 8.5
27 13 oz 6.3
30 13 oz 4.3
Powder (44 kcal/scoop)
20 1 scoop 2
24 3 scoops 5
27 3 scoops 4.25
30 3 scoops 4
a Does not apply to Enfacare LIPIL, Neocate Infant, Neosure Advance, EleCare; Enfamil AR should not be concentrated greater than 24 kcal/oz. Use a packed measure for Nutramigen LIPIL and Pregestimil LIPIL and unpacked powder for all others.
Adapted from Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
108 Reference Range Values for Pediatric Care
COMMON CALORIC SUPPLEMENTSa
Component CaloriesProtein Resource Beneprotein
(powder)25 kcal/scoop (6 g protein)
ProSource Protein Powder 30 kcal/scoop (6 g protein)
Complete Amino Acid Mix 3.28 kcal/g (0.82 g protein)
Carbohydrate Polycose Powder: 3.8 kcal/g, 8 kcal/5 mLl
Fat MCT oilb 7.7 kcal/mL
Vegetable oil 8.3 kcal/mL
Microlipid 4.5 kcal/mL
Fat and Carbo-hydrate
Duocal 42 kcal/15 mL; 25 kcal/scoop (59%carbohydrates, 41% fat; 35% fat asMCT oil)
Abbreviations: MCT, medium-chain triglyceride.a Use these caloric supplements when you want to increase protein or when you have reached the maximum concentration tolerated and wish to further increase caloric density.
b MCT oil is unnecessary unless there is fat malabsorption.
From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012.Reproduced with permission. Copyright © 2012 Elsevier.
ENTERAL FORMULAS, INCLUDING THEIR MAIN NUTRIENT COMPONENTS
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
A. INFANTS
Human Milk
Term 20 11 39 72 8 14 279 143 0.3 286
Preterm 20 14 39 66 11 15 248 128 1.2 290
Human Milk and Fortifiers Analysis
EnfamiI HMF+ preterm human milk (1 pkt/25 mL)
24 26 49 70 18 23 1148 628 15.6 325
SimiIac HMF+ preterm human milk (1 pkt/25 mL)
24 23 41 82 17 30 1381 777 4.6 N/A
109Nutrition, Formula Preparation, and Caloric Counts
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
A. INFANTS, continued
Preterm Formulas
Enfamil Premature LIPIL
20 20 34 74 17 17 1100 553 3.4 240
Good Start Premature 24
24 24 42 84 19 25 1312 680 14.4 275
NeoSure 22 21 41 75 11 27 781 461 13.4 250
EnfaCare LIPIL 22 21 39 77 11 20 890 490 13.3 260
Similac Special Care 20
20 20 37 70 13 22 1217 676 12.2 235
Similac Special Care 24 High Protein
24 27 44 81 15 27 1461 811 14.6 280
Similac Special Care 30
30 30 67 78 19 34 1826 1014 18.3 325
Cow’s Milk-Based Formulas
Enfamil Premium Lipil
20 14 36 74 8 19 520 287 12 360
Enfamil LIPIL 20 14 36 73 8 19 520 287 12 300
Enfamil AR LIPIL 20 17 34 74 12 19 520 353 12 230 (240*)
Enfamil LactoFree LIPIL
20 14 36 73 9 19 547 307 12 200
Enfamil Restfull 20 17 34 74 12 19 520 353 12 230
Enfagrow Premium NextStep
20 18 36 70 10 23 1300 867 13.4 270
Evaporated Milk (13 oz + 19 oz water + 30 mL corn syrup)
20 27 31 72 21 32 1066 832 0.8 N/A
Organic Milk-Based Infant Formula
20 15 36 71 7 15 420 280 12 294
Parent’s Choice Store Brand (also w/ARA/DHA)
20 14 36 72 8 19 520 287 12 295
*Liquid formulation
110 Reference Range Values for Pediatric Care
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
A. INFANTS, continued
Cow’s Milk-Based Formulas, continued
Similac Advance Early Shield
20 14 37 76 7 18 528 284 12 310
Similac Go & Grow Milk-Based Formula
20 14 37 72 7 18 1014 548 13.5 300
Similac Sensitive 20 14 37 72 9 19 568 379 12.2 200
Similac Organic 20 14 37 71 7 18 528 284 12.2 225
Similac PM 60/40 20 15 38 69 7 14 379 189 4.7 280
Similac Sensitive RS
20 14 37 72 9 19 568 379 12.2 180
Soy-Based Formulas
Good Start 2 Soy PLUS
20 19 34 73 12 20 1273 710 13.4 175
Good Start Soy PLUS
20 17 34 75 12 20 704 422 12.1 180
America’s Store Brand Soy (also w/ARA/DHA)
20 17 36 68 11 21 700 460 12 164
SimilacGo & Grow Soy-Based Formula
20 17 37 70 13 19 1014 676 13.5 200
Isomil Advance 20 17 37 70 13 19 710 507 12.2 200
lsomilDF 20 18 37 68 13 19 710 507 12.2 240
Enfagrow Soy NextStep
20 22 30 79 11 21 1300 867 13.3 230
Enfamil Pro-SobeeLIPIL
20 17 36 71 11 21 700 460 12 170
Casein, Extensively Hydrolyzed
Alimentum 20 19 37 69 13 20 710 507 12.2 370
Nutramigen LIPIL 20 19 36 69 14 19 627 347 12 300 (320*)
*Liquid formulation
ENTERAL FORMULAS, INCLUDING THEIR MAIN NUTRIENT COMPONENTS, continued
111Nutrition, Formula Preparation, and Caloric Counts
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
A. INFANTS, continued
Casein, Extensively Hydrolyzed, continued
Nutramigen with Enflora LGG
20 19 36 69 14 19 627 347 12 300
Pregestimil LiPiL 20 19 38 69 14 19 640 350 12.2 250
Whey, Partially Hydrolyzed
Good Start Gentle PLUS
20 15 34 78 8 19 449 255 10.1 250
Good Start Protect PLUS
20 15 34 75 8 19 449 255 10.1 250
Good Start 2 Gentle PLUS
20 15 24 78 8 19 1273 710 13.4 180
Good Start 2 Protect PLUS
20 15 34 75 8 19 1273 710 13.4 250
Whey and Casein, Partially Hydrolyzed
Enfamil Gentlease
20 15 36 72 10 19 547 307 12 230
Amino Acid-Based Formulas
EleCare (also w/DHA/ARA)
20 20 32 72 13 26 780 568 10 350
Neocate Infant (also w/DHAIARA)
20 21 30 78 11 27 830 624 12.4 375
Nutramigen AA LIPIL
20 19 36 69 14 19 627 347 12 350
Specialized Formulas
3232A 20 19 28 89 13 19 627 420 12.5 250
RCF 20 20 36 68 13 19 710 507 12.2 168
Enfaport LIPIL 30 35 54 102 13 29 940 520 18 280
112 Reference Range Values for Pediatric Care
ENTERAL FORMULAS, INCLUDING THEIR MAIN NUTRIENT COMPONENTS, continued
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
B. TODDLERS AND YOUNG CHILDREN AGES 1–10 YEARS
Cow’s Milk-Based Formulas
Boost Kid Essentials
30 30 38 135 24 30 1181 886 14 550/ 600/ 570
Boost Kid Essen-tials 1.5 (w/fiber)
45 42 75 165 30 33 1300 990 14 390 (405)
Carnation Instant Breakfast Lactose Free
30 35 37 133 38 32 500 1018 9 480/490
Carnation Instant Breakfast Lactose Free Plus
45 52 48 176 51 48 748 748 13.6 620
Carnation Instant Breakfast Lactose Free VHC
68 90 123 197 51 46 1232 1232 22.4 950
Carnation Instant Breakfast Essentials
24 43 16 105 24 27 1539 1539 13.8 N/A
Compleat Pediatric
30 38 39 126 33 42 1440 1000 13.2 380
Cow’s milk, 2% 15 35 20 50 22 41 1258 979 0.5 N/A
Cow’s milk, whole 19 34 34 48 22 40 1226 956 0.5 285
Ketocal 3:1 30 22 97 10 18 35 1140 801 16 180
KetoCal 4:1 43 30 144 6 26 55 1600 1300 22 197
Kindercal TF Vanilla
32 30 44 135 16 34 1010 850 10.6 345
Monogen 30 27 28 163 21 22 617 480 10.1 370
NutrenJunior with Fiber
30 30 50 110 20 34 1000 800 14 350
PediaSure Enteral (w/fiber)
30 30 40 133 17 34 972 845 14 335 (345)
PediaSure 1.5 with Fiber
45 59 69 160 (165)
17 42 1476 1054 11 379 (390)
PediaSure Vanilla 30 30 38 131 17 34 972 845 14 480
113Nutrition, Formula Preparation, and Caloric Counts
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
B. TODDLERS AND YOUNG CHILDREN AGES 1–10 YEARS, continued
Cow’s Milk-Based Formulas, continued
PediaSure with Fiber Vanilla
30 30 38 135 17 34 972 845 14 480
Portagen 30 32 44 104 22 29 850 642 17 350
Soy-Based Formulas
Bright Beginnings Soy Pediatric Drink
30 30 50 109 17 40 970 800 14 350
Semi-Elemental, Hydrolyzed
Peptamen Junior 1.5
45 45 68 180 30 35 1652 1352 20.8 450
Peptamen Junior Fiber
30 30 39 137 20 34 1000 800 14 365
Peptamen Junior with Prebio
30 30 39 137 20 34 1000 800 14 365
Peptamen Junior, Unflavored (w/fiber)
30 30 39 138 20 34 1000 800 14 260 (390)
Vital Junior 30 30 41 134 31 35 1055 844 13.9 390
Soy and Pork, Hydrolyzed
Pepdite Junior, unflavored
30 31 50 106 18 35 1130 940 14 430
Amino Acid-Based Formulas
EleCare (Unflavored and Vanilla)
30 31 49 109 20 39 1172 852 15 560
E028 Splash 30 25 35 146 9 24 620 620 7.7 820
NeocateJuniorFlavored
30 35 47 110 19 36 1200 738 16 690
Neocate Junior Unflavored
30 33 50 104 18 35 1130 697 15 590
Vivonex Pediatric 24 24 24 130 17 31 970 800 10 360
114 Reference Range Values for Pediatric Care
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
C. OLDER CHILDREN AND ADULTS
Cow’s Milk-Based Formulas
Boost 30 40 17 171 24 43 1250 1250 19 625
Boost High Protein
30 63 25 138 31 41 1459 1250 19 650
Boost Diabetic 32 59 50 84 48 29 1160 928 15 400
Boost High Protein
30 63 25 138 31 41 1459 1250 19 650
Boost Plus 45 59 59 188 31 41 1459 1250 19 670
Compleat 32 48 40 128 43 44 760 760 14 340
Crucial 45 94 68 134 51 48 1000 1000 18 490
Enlive 31 37 0 217 8 5 208 1166 11 825
Ensure 32 38 25 173 37 40 1266 1055 19 620
Ensure Plus 45 55 212 47 41 45 1266 2166 19 680
Glucerna 1.0 Cal 30 42 54 96 41 40 705 705 13 355
Jevity 1 Cal 32 44 35 155 40 40 910 760 14 300
Jevity 1.2 Cal 36 56 39 169 59 47 1200 1200 18 450
Jevity1.5 Cal 45 64 50 216 61 55 1200 1200 18 525
Nepro 53 81 96 167 46 27 1060 700 19 585
Novasource Renal 60 74 100 200 39 21 1300 650 18 700/ 960
Nutren 1.0 vanilla (w/fiber)
30 40 38 127 38 32 668 668 12 370 (410)
Nutren 1.5 unflavored
45 60 68 169 51 48 1000 1000 18 430
Nutren 2.0 60 80 104 196 57 49 1340 1340 24 745
Optimental 30 51 28 139 49 44 1055 1055 13 585
Osmolite 1 Cal 32 44 35 144 40 40 760 760 14 300
Osmolite 1.2 Cal 36 56 39 158 58 46 1200 1200 18 360
Osmolite 1.5 Cal 45 63 49 204 61 46 1000 1000 18 525
Promote (w/fiber) 30 63 26 130 44 51 1200 1200 18 340 (380)
Pulmocare 45 63 93 106 57 50 1060 1060 19 475
Renalcal 60 35 83 291 0 0 0 0 0 600
ENTERAL FORMULAS, INCLUDING THEIR MAIN NUTRIENT COMPONENTS, continued
115Nutrition, Formula Preparation, and Caloric Counts
Kcal/oz
Protein (g)
Fat (g)
Carbs (g)
Na (mEq)
K (mEq)
Ca (mg)
P (mg)
Fe (mg)
Osmo-lality
C. OLDER CHILDREN AND ADULTS, continued
Cow’s Milk-Based Formulas, continued
Replete, Unflavored
30 63 34 113 38 39 1000 1000 18 300/ 350
Resource 2.0 60 84 88 217 35 39 1042 1042 18.8 790
Resource Breeze 32 38 0 230 15 1 42 633 11 750
Suplena 54 45 96 205 35 29 1055 717 19 600
TwoCal HN 60 84 91 219 64 63 1050 1050 19 725
Soy-Based Formulas
Fibersource HN 36 53 39 160 52 51 1000 1000 17 490
Isosource 1.5 Cal 45 68 65 170 56 58 1070 1070 19 650/ 585
lsosource HN 36 53 39 160 48 49 1200 1200 15 490
Semi-Elemental Hydrolyzed
Peptamen, Unflavored
30 40 39 127 25 39 800 700 18 270
Peptamen with Prebio
30 40 39 127 25 39 800 700 18 300
Peptamen 1.5, Unflavored
45 68 56 188 45 48 1000 1000 27 550
Peptamen AF 36 76 55 107 35 41 800 800 14.4 390
Perative 39 67 37 180 45 44 870 870 16 460
Pivot 1.5 45 94 51 172 61 51 1000 1000 18 595
Vital 1.0 Cal 30 40 38 130 46 36 705 705 13 390
Vital HN 30 42 11 185 25 36 667 667 12 500
Amino Acid-Based Formulas
Tolerex 30 21 1.5 230 20 30 560 560 10 550
Vivonex RTF 30 50 12 175 29 31 670 670 12 630
Vivonex Plus 30 7 67 190 27 27 560 560 10 650
VivonexT.E.N. 30 38 3 210 26 24 500 500 9 630
From Arcara KM, Tschudy MM, eds.. The Harriet Lane Handbook. 19th ed. St Louis, MO: Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
116 Reference Range Values for Pediatric Care
SolutionGlucose/CHO, g/L
Sodium, mEq/L
HCO3–,
mEq/LPotassium
mEq/LOsmolality,
mmol/LCHO/
Sodium
Pedialyte (Abbott Laboratories, Columbus, OH)
25 45 30 20 250 3.1
Pediatric Electrolyte (Pendo-Pharm, Montreal, Quebec)
25 45 20 30 250 3.1
Kaolectrolyte (Pfizer, New York, NY)
20 48 28 20 240 2.4
Rehydralyte (Abbott Laborato-ries, Columbus, OH)
25 75 30 20 310 1.9
WHO ORS, 2002 (reduced osmolarity)
75 75 10b 30 224 1.0
WHO ORS, 1975, (original formulation)
111 90 10b 20 311 1.2
Colaa 126 2 13 0.1 750 1944
Apple juicea 125 3 0 32 730 1278
Gatoradea (Gatorade, Chicago, IL)
45 20 3 3 330 62.5
Abbreviations: CHO indicates carbohydrate; HCO3–, bicarbonate; WHO, World Health Organization.
a Cola, juice, and Gatorade are shown for comparison only; they are not recommended for use. Mainly for maintenance therapy; may be used for rehydration therapy in mildly dehydrated patients.
b Citrate.
From Kleinman RE, ed. Pediatric Nutrition Handbook. Elk Grove Village, IL: American Academy of Pediatrics; 2009.
COMPOSITION OF FLUIDS FREQUENTLY USED IN ORAL REHYDRATIONa
117Nutrition, Formula Preparation, and Caloric Counts
DIETARY REFERENCE INTAKES: RECOMMENDED INTAKES FOR INDIVIDUALS, FOOD AND NUTRITION BOARD, INSTITUTE OF MEDICINE
Infa
nts
0–6
mo
Infa
nts
7–12
mo
Child
ren
1–3
yCh
ildre
n 4–
8 y
Mal
es
9–13
yM
ales
14
–18
yFe
mal
es
9–13
yFe
mal
es
14–1
8 y
Preg
nanc
y ≤1
8 y
Lact
atio
n
≤18
y
Carb
ohyd
rate
(g/d
ay)
60a
95a
130
130
130
130
130
130
175
210
Tota
l Fib
er (g
/day
)N
DN
D19
a25
a31
a38
a26
a26
a28
a29
a
Fat (
g/d
ay)
31a
30a
ND
ND
ND
ND
ND
ND
ND
ND
n-6
Poly
unsa
tura
ted
Fa
tty A
cid
s (g
/day
) (L
inol
eic
Aci
d)
4.4a
4.6a
7a10
a12
a16
a10
a11
a13
a13
a
n-3
Poly
unsa
tura
ted
Fa
tty A
cid
s (g
/day
) (α
-Lin
olen
ic A
cid
)
0.5a
0.5a
0.7a
0.9a
1.2a
1.6a
1.0a
1.1a
1.4a
1.3a
Prot
ein
(g/k
g/d
ay)
1.52
a1.
2a1.
05a
0.95
a0.
95a
0.85
a0.
95a
0.85
a1.
1a1.
3a
Vita
min
A (μ
g/d
ay)b
400a
500a
300
400
600
900
600
700
750
1200
Vita
min
C (m
g/d
ay)
40a
50a
1525
4575
4565
8011
5
Vita
min
D (I
U/d
ay)c,
d40
0a40
0a60
060
060
060
060
060
060
060
0
Vita
min
E (m
g/d
ay)e
4a5a
67
1115
1115
1519
Vita
min
K (μ
g/d
ay)
2.0a
2.5a
30a
55a
60a
75a
60a
75a
75a
75a
Thia
min
(mg/
day
)0.
2a0.
3a0.
50.
60.
91.
20.
91.
01.
41.
4
Rib
oflav
in (m
g/d
ay)
0.3a
0.4a
0.5
0.6
0.9
1.3
0.9
1.0
1.4
1.6
Nia
cin
(mg/
day
)f2a
4a6
812
1612
1418
17
Vita
min
B6 (
mg/
day
)0.
1a0.
3a0.
50.
61.
01.
31.
01.
21.
92.
0
Fola
te (μ
g/d
ay)g
65a
80a
150
200
300
400
300
400h
600i
500
Vita
min
B12
(μg/
day
)0.
4a0.
5a0.
91.
21.
82.
41.
82.
42.
62.
8
Pant
othe
nic
Aci
d
(mg/
day
)1.
7a1.
8a2a
3a4a
5a4a
5a6a
7a
Biot
in (μ
g/d
ay)
5a6a
8a12
a20
a25
a20
a25
a30
a35
a
Calc
ium
(mg/
day
)20
0a26
0a70
0a10
00a
1300
a13
0013
0013
0013
0013
00
Chol
inej (
mg/
day
)12
5a15
0a20
0a25
0a37
5a55
0a37
5a40
0a45
0a55
0a
Chro
miu
m (μ
g/d
ay)
0.2a
5.5a
11a
15a
25a
35a
21a
24a
29a
44a
118 Reference Range Values for Pediatric CareIn
fant
s 0–
6 m
oIn
fant
s 7–
12 m
oCh
ildre
n 1–
3 y
Child
ren
4–8
yM
ales
9–
13 y
Mal
es
14–1
8 y
Fem
ales
9–
13 y
Fem
ales
14
–18
yPr
egna
ncy
≤18
yLa
ctat
ion
≤1
8 y
Cop
per
(μg/
day
)20
0a22
0a34
044
070
089
070
089
010
0013
00
Fluo
ride
(mg/
day
)0.
01a
0.5a
0.7a
1a2a
3a3a
3a3a
3a
Iod
ine
(μg/
day
)11
0a13
0a90
9012
015
012
015
022
029
0
Iron
(mg/
day
)0.
27a
117
108
118
1527
10
Mag
nesi
um (m
g/d
ay)
30a
75a
8013
024
041
024
036
040
036
0
Man
gane
se (m
g/d
ay)
0.00
3a0.
6a1.
2a1.
5a1.
9a2.
2a1.
6a1.
6a2.
0a2.
6a
Mol
ybd
enum
(μg/
day
)2a
3a17
2234
4334
4350
50
Phos
pho
rus
(mg/
day
)10
0a27
5a46
050
012
5012
5012
5012
5012
5012
50
Sele
nium
(μg/
day
)15
a20
a20
3040
5540
5560
70
Zinc
(mg/
day
)2a
33
58
118
912
13
Pota
ssiu
m (g
/day
)0.
4a0.
7a3.
0a3.
8a4.
5a4.
7a4.
5a4.
7a4.
7a5.
1a
Sod
ium
(g/d
ay)
0.12
a0.
37a
1.0a
1.2a
1.5a
1.5a
1.5a
1.5a
1.5a
1.5a
Chlo
ride
(g/d
ay)
0.18
a0.
57a
1.5a
1.9a
2.3a
2.3a
2.3a
2.3a
2.3a
2.3a
Not
e: T
his
tabl
e (t
aken
from
the
DR
I re
port
s; s
ee w
ww.
nas
.edu
) pr
esen
ts r
ecom
men
ded
diet
ary
allo
wan
ces
(RD
As)
in b
old
type
, an
d ad
equa
te in
take
s (A
Is)
are
in o
rdin
ary
type
follo
wed
by
the
sym
bol (
a ). N
D in
dica
tes
not
det
erm
ined
.a R
DA
s an
d A
Is m
ay b
oth
be
used
as
goal
s fo
r in
divi
dual
inta
ke. R
DA
s ar
e se
t to
mee
t th
e n
eeds
of a
lmos
t all
(97%
–98%
) in
divi
dual
s in
a g
roup
. For
hea
lth
y br
east
fed
infa
nts
, th
e A
I is
the
mea
n in
take
. Th
e A
I fo
r ot
her
life
sta
ge a
nd
gen
der
grou
ps is
bel
ieve
d to
cov
er n
eeds
of a
ll in
divi
dual
s in
the
grou
p, b
ut la
ck o
f dat
a or
un
cert
ain
ty in
the
data
pr
even
t bei
ng
able
to s
peci
fy w
ith
con
fide
nce
the
perc
enta
ge o
f in
divi
dual
s co
vere
d by
this
inta
ke.
b As
reti
nol
act
ivit
y eq
uiva
len
ts (
RA
Es)
. 1 R
AE
= 1
μg
reti
nol
, 12
μg β
-car
oten
e, 2
4 μg
α-c
arot
ene,
or
24 μ
g β-
cryp
toxa
nth
in in
food
s. T
he
RA
E fo
r di
etar
y pr
ovit
amin
A c
arot
-en
oids
is
twof
old
grea
ter
than
ret
inol
equ
ival
ents
(R
E),
wh
erea
s th
e R
AE
for
pref
orm
ed v
itam
in A
is th
e sa
me
as R
E.
c As
chol
ecal
cife
rol.
1 μg
ch
olec
alci
fero
l = 4
0 IU
vit
amin
D.
d In
the
abse
nce
of a
dequ
ate
expo
sure
to s
unlig
ht.
e As
α-to
coph
erol
. α-T
ocop
her
ol in
clud
es R
RR
-α-to
coph
erol
, th
e on
ly fo
rm o
f α-to
coph
erol
that
occ
urs
nat
ural
ly in
food
s, a
nd
the
2R-s
tere
oiso
mer
ic fo
rms
of α
-toco
pher
ol
(RR
R-,
RSR
-, R
RS-
, an
d R
SS-α
-toco
pher
ol)
that
occ
ur in
fort
ified
food
s an
d su
pple
men
ts. I
t doe
s n
ot in
clud
e th
e 2S
-ste
reoi
som
eric
form
s of
α-to
coph
erol
(SR
R-,
SSR
-, SR
S-,
and
SSS-
α-to
coph
erol
), a
lso
foun
d in
fort
ified
food
s an
d su
pple
men
ts.
f As
nia
cin
equ
ival
ents
(N
Es)
. 1 m
g of
nia
cin
= 6
0 m
g of
tryp
toph
an; 0
–6 m
o =
pref
orm
ed n
iaci
n (
not
NE
s).
g A
s di
etar
y fo
late
equ
ival
ents
(D
FEs)
. 1 D
FE =
1 μ
g fo
od fo
late
= 0
.6 μ
g of
folic
aci
d fr
om fo
rtifi
ed fo
od o
r as
a s
uppl
emen
t con
sum
ed w
ith
food
= 0
.5 μ
g of
a s
uppl
emen
t ta
ken
on
an
em
pty
stom
ach
.h In
vie
w o
f evi
den
ce li
nki
ng
fola
te in
take
wit
h n
eura
l tub
e de
fect
s in
the
fetu
s, it
is r
ecom
men
ded
that
all
wom
en c
apab
le o
f bec
omin
g pr
egn
ant c
onsu
me
400
μg fr
om
supp
lem
ents
or
fort
ified
food
s in
add
itio
n to
inta
ke o
f foo
d fo
late
from
the
diet
.i I
t is
assu
med
that
wom
en w
ill c
onti
nue
con
sum
ing
400
μg fr
om s
uppl
emen
ts o
r fo
rtifi
ed fo
od u
nti
l th
eir
preg
nan
cy is
con
firm
ed a
nd
they
en
ter
pren
atal
car
e, w
hic
h o
rdin
ari-
ly o
ccur
s af
ter
the
end
of th
e pe
rico
nce
ptio
nal
per
iod—
the
crit
ical
tim
e fo
r fo
rmat
ion
of t
he
neu
ral t
ube.
j Alt
hou
gh A
Is h
ave
been
set
for
chol
ine,
ther
e ar
e fe
w d
ata
to a
sses
s w
het
her
a d
ieta
ry s
uppl
y of
ch
olin
e is
nee
ded
at a
ll st
ages
of t
he
life
cycl
e, a
nd
it m
ay b
e th
at th
e ch
olin
e re
quir
emen
t can
be
met
by
endo
gen
ous
syn
thes
is a
t som
e of
thes
e st
ages
.
Cop
yrig
ht 2
004
by T
he
Nat
ion
al A
cade
mie
s of
Sci
ence
s. A
ll ri
ghts
res
erve
d.
DIETARY REFERENCE INTAKES: RECOMMENDED INTAKES FOR INDI VID UALS, FOOD AND NUTRITION BOARD, INSTITUTE OF MEDICINE, continued
119Nutrition, Formula Preparation, and Caloric Counts
FLUORIDE SOURCES AND SUPPLEMENTATION
Topical Fluoride Sources
Source Availability Concentration Typical DoseToothpaste OTC 1,000 –1,500 ppm Pea sized = 0.25 mg
Toothpaste Prescription 5,000 ppm Pea sized = 1.25 mg
Varnish Professionally applied 22,600 ppm (NaF) 0.2 mL = 4.4 mg
Gel Professionally applied 12,300 ppm (1.23%) 5 mL = 61.5 mg
Gel Prescription 5,000 ppm (0.5% NaF)
Thin ribbon = 25 mg
Foam Professionally applied 9,040 ppm (0.9%) 5 mL = 45 mg
Rinse OTC 230 ppm (0.05% NaF) 5 mL = 2.5 mg
From Slayton R. Fluoride facts: what pediatricians need to know about fluoride agents for children, including supplementation. AAP News. 2010;31:30
Dietary Fluoride Supplementation Schedule
Age <0.3 ppm F 0.3–0.6 ppm F >0.6 ppm FBirth–6 months 0 0 0
6 months–3 years 0.25 mg 0 0
3–6 years 0.50 mg 0.25 mg 0
6 years up to at least 16 years
1.00 mg 0.50 mg 0
From American Academy of Pediatric Dentistry Liaison with Other Groups Committee; American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on fluoride therapy. Pediatr Dent. 2008–2009;30(7 suppl):121–124. Reproduced with permission. Copyright © 2008–2009 American Academy of Pediatric Dentistry.
121
9. Umbilical Vein and Artery Catheterization Measurements
USING BIRTH WEIGHT TO MEASURE CATHETER LENGTHPrior to placing an umbilical vein or artery catheter in a newborn as an elective procedure, you can use the following regression formula to determine the catheter length in centimeters using birth weight:
Umbilical Artery Catheter Length (cm) = 3 × Birth Weight + 9 cm
Umbilical Vein Catheter Length (cm) = Umbilical Artery Catheter Length (cm) + 1 cm
2
You can use this formula to approximate the length necessary for place-ment of a high-lying line between T6 and T10 for umbilical artery lines and umbilical vein lines above the level of the diaphragm in the inferior vena cava. Correct placement in small for gestational age (SGA) and large for gestational age (LGA) babies may vary because the formula is only an approximation. Radiographic confirmation of line positioning is important to avoid complications.
122 Reference Range Values for Pediatric Care
30
25
20
15
10
5
15
10
5
0 1000 2000 3000 4000 5000 6000
Inte
rnal
Cat
hete
r Le
ngth
, cm
Birth Weight, g
Estimate of Insertional Length of Umbilical Catheters Based on Birth Weight With 95% Confidence Intervals
Umbilical catheters (umbilical artery catheter tip inserted between T-6 and T-10; umbilical vein catheter tip inserted above diaphragm in interior vena cava near or in right atrium). Modified estimating equations utilizing birth weight (BW) are as follows: umbilical artery length = 2.5*BW + 9.7 (top graph) and umbilical vein length = 1.5*BW + 5.6 (bottom graph), where BW is measured in kilograms and lengths in centimeters.
From Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140(8):786–788. Copyright © 1986 American Medical Association. All rights reserved.
123Umbilical Vein and Artery Catheterization Measurements
USING SHOULDER-UMBILICAL LENGTH TO MEASURE UMBILICAL ARTERY CATHETER LENGTH
The graph shows the length of catheter necessary to reach the aortic valve, diaphragm, or aortic bifurcation. Ideally, the umbilical artery catheter should reach the level of the diaphragm for a high-lying line. Measure the shoulder- umbilical length by drop-ping a vertical line from the tip of the shoulder to a point vertically beneath it that is level with the center of the umbilicus. Plot this length on the x-axis of the graph. Where the line intersects the graph of the diaphram, plot a line to the y-axis.
28
26
24
22
20
18
16
14
12
10
8
6
48 10 12 14 16 18
Um
bili
cal A
rter
y Ca
thet
er (
cm)
Shoulder-UmbilicalLength (cm)
Aorti
c Va
lve
Diaphr
agm
Bifurca
tion of A
orta
Umbilical Artery Catheter Length
124 Reference Range Values for Pediatric Care
USING SHOULDER-UMBILICAL LENGTH TO MEASURE UMBILICAL VEIN CATHETER LENGTH
The graph shows the length of catheter necessary to reach the left side of the atrium and the diaphragm. Ideally, the umbilical vein catheter should reach the level of the diaphragm. Measure the shoulder-umbilical length by dropping a vertical line from the tip of the shoulder to a point vertically beneath it that is level with the center of the umbilicus. Plot this length on the x-axis of the graph. Where the line intersects the graph of the diaphragm, plot a line to the y-axis.
13
12
11
10
9
8
7
6
5
48 9 10 11 12 13 14 15 16 17
Um
bili
cal V
ein
Cath
eter
(cm
)
Shoulder-Umbilical Length (cm)
Left A
trium
Diaphragm
Umbilical Vein Catheter Length
125
10. Doses and Levels of Common Anti-biotic and Antiseizure Medications
ANTIBIOTICS
AMIKACIN ............................................................................. 126
GENTAMICIN.......................................................................... 128
TOBRAMYCIN ......................................................................... 130
VANCOMYCIN ........................................................................ 132
ANTISEIZURE
FOSPHENYTOIN ..................................................................... 134
LEVETIRACETAM ..................................................................... 136
PHENOBARBITAL .................................................................... 138
TOPIRAMATE ......................................................................... 140
VALPORIC ACID AND DERIVATIVES........................................... 142
126 Reference Range Values for Pediatric Care
ANTIBIOTICS
Amikacin
Neonatal Dosing
Dosing Table for IV Systemic Administration PMA (wk) Postnatal (d) Dose (mg/kg) Interval (h)
≤29 0–7 8–28 ≥29
18 15 15
48 36 24
30–34 0–7 ≥8
18 15
36 24
≥35 All 15 24
Abbreviation: PMA, postmenstrual age.
Infant, Children, and Adolescent Dosing
CONVENTIONAL DOSING: 5 to 7.5 mg/kg/dose every 8 hoursDOSAGE FOR RENAL IMPAIRMENT: Yes
Monitoring in neonates
WHEN TO DRAW LEVELS
• Peak: After second dose (see “Timing of Levels”).• Trough: After second dose (just before third dose).• Levels are unnecessary if patient is on antibiotics for 48 to 72 hour
rule-out sepsis protocol.• Consider more frequent monitoring in hypothermia treatment.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Amikacin peak: 20 to 25 mcg/mL• Amikacin trough: <5 mcg/mL
127Doses and Levels of Common Anti biotic and Antiseizure Medications
Monitoring in Infants, Children, and Adolescents
WHEN TO DRAW LEVELS
• Peak: After second dose (see “Timing of Levels”).• Trough: After second dose (just before third dose).• Levels may be unnecessary if patient is on antibiotics for 48 to
72 hours sepsis protocol.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Amikacin peak: 20 to 30 mcg/mL• Amikacin trough: 4 to 10 mcg/mL
128 Reference Range Values for Pediatric Care
Gentamicin
Neonatal Dosing
Dosing Table for IV Systemic Administration PMA (wk) Postnatal (d) Dose (mg/kg) Interval (h)
≤29 0–7 8–28 ≥29
5 4 4
48 36 24
30–34 0–7 ≥8
4.5 4
36 24
≥35 All 4 24
Abbreviation: PMA, postmenstrual age.
Infant, Children, and Adolescent Dosing
CONVENTIONAL DOSING:
• Infants and children younger than 5 years: 2.5 mg/kg/dose every 8 hours
• Children 5 years and older: 2 to 2.5 mg/kg/dose every 8 hours
HIGH-DOSE, EXTENDED INTERVAL DOSING (IN PATIENTS WITH NORMAL RENAL
FUNCTION): 5 to 7.5 mg/kg/dose every 24 hours
DOSAGE FOR RENAL IMPAIRMENT: Yes
Monitoring in Neonates
WHEN TO DRAW LEVELS
• Peak: After second dose (see “Timing of Levels”).• Trough: After second dose (just before third dose).• Levels are unnecessary if patient is on antibiotics for 48 to 72 hour
rule-out sepsis protocol.• Consider more frequent monitoring in hypothermia treatment.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
129Doses and Levels of Common Anti biotic and Antiseizure Medications
GOAL LEVELS
• Gentamicin peak: 6 to 12 mcg/mL (3 to 5 is an acceptable range for gram-positive synergy)
• Gentamicin trough: <1 mcg/mL
Gentamicin Dose and Monitoring Recommendations for HIE Cooling PatientsWHEN TO DRAW LEVELS
• First levels done as described above.• Repeat peak and trough levels after rewarming.
— Peak: After forth dose (see “Timing of Levels”) — Trough: Before fourth dose
• Levels are unnecessary if patient is on antibiotics for 48 to 72 hour rule-out sepsis protocol.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
Monitoring in Infants, Children, and AdolescentsWHEN TO DRAW LEVELS
• Peak: After third dose (see “Timing of Levels”).• Trough: After third dose.• Levels may be unnecessary if patient is on antibiotics for 48 to
72 hour rule-out sepsis protocol.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Gentamicin peak (conventional dosing): 6 to12 mcg/mL (3 to 5 is an acceptable range for gram-positive synergy)
• Gentamicin peak (high-dose, extended interval dosing): May be 2 to 3 times greater than conventional dosing peak levels
• Gentamicin trough: <2 mcg/mL ( <1 mcg/mL is ideal, especially for high-dose, extended interval)
130 Reference Range Values for Pediatric Care
Tobramycin
Neonatal Dosing
Dosing Table for IV Systemic Administration PMA (wk) Postnatal (d) Dose (mg/kg) Interval (h)
≤29 0–7 8–28 ≥29
5 4 4
48 36 24
30–34 0–7 ≥8
4.5 4
36 24
≥35 All 4 24
Abbreviation: PMA, postmenstrual age.
Infant, Children, and Adolescent Dosing
CONVENTIONAL DOSING:
• Infants and children younger than 5 years: 2.5 mg/kg/dose every 8 hours
• Children 5 years and older: 2 to 2.5 mg/kg/dose every 8 hours
CYSTIC FIBROSIS DOSING:
• Conventional CF dosing: 3.3 mg/kg/dose every 8 hours• High-dose, extended interval dosing: 7 mg/kg/dose every 12 hours
or 10 mg/kg/dose every 24 hours
DOSAGE FOR RENAL IMPAIRMENT: Yes
Monitoring in Neonates
WHEN TO DRAW LEVELS
• Peak: After second dose (see “Timing of Levels”).• Trough: After second dose (just before third dose).• Levels are unnecessary if patient is on antibiotics for 48 to 72 hour
rule-out sepsis protocol.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
131Doses and Levels of Common Anti biotic and Antiseizure Medications
GOAL LEVELS
• Tobramycin peak: 6 to 12 mcg/mL (3 to 5 mcg/mL is an acceptable range for gram-positive synergy)
• Tobramycin trough: <1 mcg/mL
Monitoring in Infants, Children, and Adolescents
WHEN TO DRAW LEVELS
• Peak: After third dose (see “Timing of Levels”).• Trough: Prior third dose.• Levels may be unnecessary if patient is on antibiotics for 48 to 72
hour rule-out sepsis protocol.
TIMING OF LEVELS
• Peak: 30 minutes after end of 30-minute infusion• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Tobramycin peak (non–cystic fibrosis dosing): 6 to12 mcg/mL (3 to 5 mcg/mL is an acceptable range for gram-positive synergy)
• Tobramycin peak (cystic fibrosis dosing): 8 to 14 mcg/mL• Tobramycin trough: <2 mcg/mL (<1 mcg/mL is ideal)
132 Reference Range Values for Pediatric Care
Vancomycin
Neonatal Dosing
Meningitis: 15 mg/kg/doseBacteremia: 10 mg/kg/dose
Dosing Table for IV Administration PMA (wk) Postnatal (d) Interval (h)
≤29 0–14 >14
18 12
30–36 0–14 >14
12 8
37–44 0–7 >7
12 8
Abbreviation: PMA, postmenstrual age.
Infants, Children, and Adolescent Dosing
CONVENTIONAL DOSING: 15 to 20 mg/kg/dose every 6 to 8 hours (Consider every 6 hours for patients older than 2 months who do not have a history of cardial abnormalities.)
DOSAGE FOR RENAL IMPAIRMENT: Yes
Monitoring in Neonates
TROUGHS ONLY EXCEPT WITH
• Central nervous system infections• Osteomyelitis• Infective abscess• Goal trough >10 mcg/mL
Monitoring in Infants, Children, and AdolescentsOnly trough levels are recommended.
WHEN TO DRAW LEVELS
• Trough: Before third dose (for neonates) or fourth dose(for infants, children, and adolescents)
• Peak: After third dose (when necessary)
133Doses and Levels of Common Anti biotic and Antiseizure Medications
TIMING OF LEVELS
• Peak: 60 minutes after end of 60-minute infusion• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Trough for neonates: 5 to 15 mcg/mL• Trough for non-neonates: 10 to 20 mcg/mL
— Consider higher goal of 10 to 15 mcg/mL (for neonates) or 15 to 20 mcg/mL (for infants, children, and adolescents) for serious infections or anatomic sites with difficult penetration (eg, meningitis, osteomylitis, bacteremia, endocarditis, hospital- acquired pneumonia caused by Staphylococcus aureus) upon recommendation from pediatric infectious diseases or clinical pharmacist.
• Peak: 25 to 40 mcg/mL
134 Reference Range Values for Pediatric Care
ANTISEIZURE
FosphenytoinNote: All dosing is expressed in phenytoin equivalents (PE). 1 mg of fosphenytoin = 1 mg of phenytoin.
Neonatal Dosing
LOADING DOSE: 15 to 20 mg PE/kg IM or IV infusion over at least 10 minutes.
MAINTENANCE DOSE: 4 to 8 mg PE/kg IM or IV slow push every 24 hours. Begin maintenance 24 hours after loading dose.
Term infants older than 1 week may require up to 8 mg PE/kg/dose every 8 to 12 hours.
Infants, Children, and Adolescent Dosing
LOADING DOSE
• Status epilepticus: 15 to 20 mg PE/kg IV• Non-emergent: 10 to 20 mg PE/kg IV or IM
MAINTENANCE DOSE: 4 to 6 mg PE/kg IV every day in 2 to 3 divided doses
Monitoring
WHEN TO DRAW LEVELS
• Monitor the drug via phenytoin levels in serum.• Consider obtaining a level 2 hours (if IV infusion) or 4 hours (if IM
infusion) after administration of the loading dose.• Achieving a steady state takes about 1 week, but you may want to take
a level if patient continues to seize.• Maintenance doses may be titrated if symptomatic, even if levels
are pending.• Consider obtaining serum albumin level.
TIMING OF LEVELS
Trough: Before steady-state dose
135Doses and Levels of Common Anti biotic and Antiseizure Medications
GOAL LEVELS
• Total phenytoin level — First week of life: 6 to 15 mcg/mL — After 7 days of life: 10 to 20 mcg/mL
• Free (unbound) level — 1 to 2 mcg/mL
136 Reference Range Values for Pediatric Care
Levetiracetam (Keppra)
Neonatal DosingNote: Limited data available; dose not established.
IV: 10 mg/kg/day divided twice daily; increase dosage by 10 mg/kg over 3 days to 30 mg/kg/day; additional increases up to 45 to 60 mg/kg/day have been used with persistent seizure activity or clinical EEG findings. For treatment of status epilepticus, loading doses of 20 to 30 mg/kg/dose have been used by some centers.
ORAL: Initial, 10 mg/kg/day in 1 to 2 divided doses; increase daily by 10 mg/kg to 30 mg/kg/day (maximum reported dose: 60 mg/kg/day).
Infants, Children, and Adolescent Dosing
PARTIAL ONSET SEIZURES
• Infants between 1 and 6 months of age: 7 mg/kg/dose twice daily; can increase dosage every 2 weeks by 7 mg/kg/dose twice daily, as tolerated, to the recommended dose of 20 mg/kg/dose twice daily. Additional increases up to 45 to 60 mg/kg/day have been used with persistent seizure activity or clinical EEG findings. Commonly accept-ed maximum dose at most centers is 60 mg/kg/day.
• Infants older than 6 months and adolescents younger than 16 years: 10 mg/kg/dose IV/PO twice daily. May increase dose every 2 weeks by 10 mg/kg/dose, if tolerated, to a maximum of 60 mg/kg/day.
• Adolescents 16 years and older: 500 mg twice daily; may increase every 2 weeks by 500 mg/dose to the recommended dose of 1,500 mg twice daily. Efficacy of doses other than 3,000 mg/day has not been established. The same dose is indicated for myoclonic seizures in this patient population.
SEIZURE PROPHYLAXIS
• Loading dose: 20 mg/kg IV• Maintenance dose: 10 mg/kg/dose twice daily for 7 days
137Doses and Levels of Common Anti biotic and Antiseizure Medications
STATUS EPILEPTICUS
Note: Limited data available; dose not established.
Loading dose of 50 mg/kg/dose (maximum dose: 2,500 mg) given IV; followed by IV or oral maintenance dosing determined by clinical response; reported IV maintenance dose is 30 to 55 mg/kg/day, divided twice daily
MonitoringTrough concentrations are not routinely measured but may be useful in accessing magnitude of dosing adjustments, drug compliance, or both.
THERAPEUTIC CONCENTRATIONS: 10 to 40 mcg/mL
138 Reference Range Values for Pediatric Care
Phenobarbital
Neonatal Dosing
ANTICONVULSANT
• Loading dose: 20 mg/kg IV, given slowly over 10 to 15 minutes.• Refractory seizures: Additional 5 mg/kg doses, up to a total of
40 mg/kg.• Maintenance dosing: 3 to 4 mg/kg/day, beginning 12 to 24 hours
after the load. Increase to 5 mg/kg/day if needed (usually by second week of therapy).
• Frequency/Route: Every 24 hours. IV slow push (most rapid control of seizures), IM, orally, or rectally.
NEONATAL ABSTINENCE SYNDROME
• Loading dose: 16 mg/kg orally on day 1.• Maintenance: 1 to 4 mg/kg/dose orally every 12 hours.• Based on abstinence scoring, weaning can be achieved by decreasing
dose 20% every other day.
Infants, Children, and Adolescents
ANTICONVULSANT LOADING DOSE
15 to 20 mg/kg (maximum: 1,000 mg/dose)
MAINTENANCE DOSING
Age Maintenance DosingInfant 5–6 mg/kg/day divided in 1–2 doses
Children 1 to 5 y 6–8 mg/kg/day divided in 1–2 doses
Children 5 to 12 y 4–6 mg/kg/day divided in 1–2 doses
Adolescents >12 y 1–3 mg/kg/day divided in 1–2 doses
139Doses and Levels of Common Anti biotic and Antiseizure Medications
Monitoring
WHEN TO DRAW LEVELS
• Achieving a steady state takes 1 to 2 weeks, but you may want to take a level if patient continues to seize.
• Maintenance doses may be titrated if symptomatic, even if levels are pending.
TIMING OF LEVELS
Trough: Before steady-state dose
GOAL LEVELS
Trough: 15 to 40 mcg/mL
140 Reference Range Values for Pediatric Care
Topiramate (Topomax)
Neonatal DosingNote: Limited data. Further studies needed.
NEONATAL SEIZURES, REFRACTORY: Oral, 10 mg/kg/day
NEUROPROTECTANT FOLLOWING ANOXIC INJURY (WITH COOLING): Oral, 5 mg/kg/day
Infants, Children, and Adolescents
ANTICONVULSANT MONOTHERAPY
Children 2 to younger than 10 years of ageInitial: 25 mg once daily (in evening); may increase, if tolerated to 25 mg twice daily in week 2; thereafter, may increase by 25 to 50 mg/day at weekly intervals over 5 to 7 weeks up to the lower end of the target daily maintenance dosing range in the following table:
≤11 kg: 150–250 mg/day in 2 divided doses 12–22 kg: 200–300 mg/day in 2 divided doses 23–31 kg: 200–350 mg/day in 2 divided doses 32–38 kg: 250–350 mg/day in 2 divided doses >38 kg: 250–400 mg/day in 2 divided doses
Children 10 years and older and adolescentsInitial: 25 mg twice daily; increase at weekly intervals by 50 mg/day up to a dose of 100 mg twice daily (week 4 dose); thereafter, may further increase at weekly intervals by 100 mg/day up to the recommended maximum dose of 200 mg twice daily
ANTICONVULSANT ADJUNCTIVE THERAPY
Children and adolescents 2 to 16 years of ageInitial: 1 to 3 mg/kg/day (maximum: 25 mg) given nightly for 1 week; increase at 1- to 2-week intervals by 1 to 3 mg/kg/day given in 2 divided doses; titrate dose to response; usual maintenance: 5 to 9 mg/kg/day given in 2 divided doses. Slower titrations rates should be utilized in generalized tonic clonic seizures.
141Doses and Levels of Common Anti biotic and Antiseizure Medications
Adolescents 17 years and olderInitial: 25 to 50 mg/day given daily for 1 week; increase at weekly intervals by 25 to 50 mg/day divided into 2 doses. Doses are titrated response with a usual maintenance dose of 100 to 200 mg twice daily (maximum dose: 1,600 mg/day). Slower titrations rates should be utilized in generalized tonic clonic seizures.
MonitoringMeasure serum bicarbonate levels at baseline and periodically during treatment. Routine monitoring of levels may be unnecessary, but con-sider target concentrations of 5 to 20 ng/mL.
142 Reference Range Values for Pediatric Care
Valproic Acid and Derivatives
Infants, Children, Adolescent DosingNote: due to the risk of valproic acid associated hepatotoxicity in patients younger than 2 years of age, valproic acid is not the preferred agent in this population.
SEIZURE DISORDER
• Oral: 10 to 15 mg/kg/day divided 3 to 4 times daily (valproic acid) or twice daily (divalproex sodium). Doses can be increased at weekly intervals to a maximum dose of 60 mg/kg/day.
• IV: Total daily dose IV is equal to total daily dose oral; however, IV should be divided into a frequency of every 6 hours.
REFACTORY STATUS EPILEPTICUS
• Loading dose: 20 to 40 mg/kg (maximum: 1,000 mg)• Continuous infusion (to begin after loading dose): 1 mg/kg/h
WHEN TO DRAW LEVELS
• Drug is monitored via trough valproic acid levels. • Should also consider obtained liver enzymes, serum ammonia,
and CBC/platelets.
TIMING OF LEVELS: Trough before steady-state dose
GOAL LEVELS: Therapeutic: 50 to 100 mcg/mL (therapeutic levels are not well established; higher goal levels may be indicated in certain patients, but should consider a neurology consult)
RESOURCESLexicomp Online. Lexi-comp , Inc; 2013. http://online.lexi.com. Accessed December 23, 2013
Mark LF, Solomon A, Northington FJ, Lee CK. Gentamicin pharmacokinetics in neonates undergoing therapeutic hypothermia. Ther Drug Monit. 2013;35(2):217–222.
Neofax Online. Truven Health Analytics Inc; 2013. http://www.micromedex.com. Accessed December 23, 2013
143Appendices
11. Appendixes
ACETAMINOPHEN TOXICITY NOMOGRAM .............................. 144
RABIES GUIDELINES ................................................................ 145
IMMUNIZATION SCHEDULES
RECOMMENDED IMMUNIZATION SCHEDULE FOR PERSONS AGED 0 THROUGH 18 YEARS— UNITED STATES, 2014 ....................................................... 146
CATCH-UP IMMUNIXATION SCHEDULE FOR PERSONS AGED 4 MONTHS THROUGH 18 YEARS WHO START LATE OR WHO ARE MORE THAN 1 MONTH BEHIND—UNITED STATES, 2014 ........................ 148
PERIODICITY SCHEDULE ................................................ SEE INSERT
FRENCH CATHETER SCALE.............................................. SEE INSERT
144 Reference Range Values for Pediatric Care
ACETAMINOPHEN TOXICITY NOMOGRAM
Adapted from Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics. 1975;55(6):871–876, and Rumack BH. Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol. 2002;40(1):3–20.
145Appendices
RABIES GUIDELINES
Rabies Postexposure Prophylaxis (PEP) Schedule—United States, 2010
Vaccination status Intervention Regimena
Not previously vaccinated
Wound cleansing All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., povidine-iodine solution) should be used to irrigate the wounds.
Human rabies immune globulin (HRIG)
Administer 20 IU/kg body weight. If anatomically fea-sible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
Vaccine Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid areab), 1 each on days 0,c 3, 7 and 14.d
Previously vaccinatede
Wound cleansing All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds.
HRIG HRIG should not be administered.
Vaccine HDCV or PCECV 1.0 mL, IM (deltoid areab), 1 each on days 0c and 3.
a These regimens are applicable for persons in all age groups, including children.b The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children, the outer aspect of the thigh may be used. Vaccine should never be adminis-tered in the gluteal area.
c Day 0 is the day dose 1 of vaccine is administered.d For persons with immunosuppression, rabies PEP should be administered using all 5 doses of vaccine on days 0, 3, 7, 14, and 28.
e Any person with a history of pre-exposure vaccination with HDCV, PCECV, or rabies vaccine ad-sorbed (RVA); prior PEP with HDCV, PCECV or RVA; or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination.
From Rupprecht CE, Briggs D, Brown CM, Franka R, Katz SL, Kerr HD, Lett SM, Levis R, Meltzer MI, Schaffner W, Cieslak PR; Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010 Mar 19;59(RR-2):1-9. Erratum in: MMWR Recomm Rep. 2010 Apr 30;59(16):493.
146 Reference Range Values for Pediatric CareRe
com
men
ded
Imm
uniz
atio
n Sc
hedu
les f
or P
erso
ns A
ged
0 Th
roug
h 18
Yea
rsU
NIT
ED S
TATE
S, 2
014
The
Reco
mm
end
ed Im
mu
niz
atio
n S
ched
ule
s fo
r Pe
rso
ns
Ag
ed 0
Th
rou
gh
18
Year
s ar
e ap
pro
ved
by
the
Ad
viso
ry C
om
mit
tee
on
Imm
un
izat
ion
Pra
ctic
es
(htt
p:/
/ww
w.c
dc.
go
v/va
ccin
es/a
cip
)
Am
eric
an A
cad
emy
of P
edia
tric
s (h
ttp
://w
ww
.aap
.org
)
Am
eric
an A
cad
emy
of F
amily
Ph
ysic
ian
s (h
ttp
://w
ww
.aaf
p.o
rg)
Am
eric
an C
olle
ge
of O
bst
etri
cian
s an
d G
ynec
olo
gis
ts(h
ttp
://w
ww
.aco
g.o
rg)
This
sch
edul
e in
clud
es re
com
men
datio
ns in
effe
ct a
s of
Janu
ary
1, 2
014.
Any
dos
e no
t adm
inis
tere
d at
the
reco
mm
ende
d ag
e sh
ould
be
adm
inis
tere
d at
a s
ubse
quen
t vis
it, w
hen
indi
cate
d an
d fe
asib
le. T
he u
se o
f a
com
bina
tion
vacc
ine
gene
rally
is p
refe
rred
ove
r sep
arat
e in
ject
ions
of i
ts e
quiv
alen
t com
pone
nt v
acci
nes.
Vacc
inat
ion
prov
ider
s sh
ould
con
sult
the
rele
vant
Adv
isor
y Co
mm
ittee
on
Imm
uniz
atio
n Pr
actic
es (A
CIP)
st
atem
ent f
or d
etai
led
reco
mm
enda
tions
, ava
ilabl
e on
line
at h
ttp:
//w
ww
.cdc
.gov
/vac
cine
s/hc
p/ac
ip-r
ecs/
inde
x.ht
ml.
Clin
ical
ly s
igni
fican
t adv
erse
eve
nts
that
follo
w v
acci
natio
n sh
ould
be
repo
rted
to th
e Va
ccin
e Ad
vers
e Ev
ent
Repo
rtin
g Sy
stem
(VA
ERS)
onl
ine
(htt
p://
ww
w.v
aers
.hhs
.gov
) or b
y te
leph
one
(800
-822
-796
7).
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
sCe
nter
s fo
r Dis
ease
Con
trol
and
Pre
vent
ion
147Appendices
Figu
re 1
. Rec
omm
ende
d im
mun
izat
ion
sche
dule
for p
erso
ns a
ged
0 th
roug
h 18
yea
rs –
Uni
ted
Stat
es, 2
014.
(F
OR
THO
SE W
HO
FA
LL B
EHIN
D O
R ST
ART
LAT
E, S
EE T
HE
CATC
H-U
P SC
HED
ULE
[FIG
URE
2]).
Th
ese
reco
mm
enda
tions
mus
t be
read
with
the
foot
note
s tha
t fol
low
. For
thos
e w
ho fa
ll be
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, pro
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in F
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To
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wee
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ses,
see
the
catc
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sche
dule
(Fig
ure
2). S
choo
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ry a
nd a
dole
scen
t vac
cine
age
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hig
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re
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men
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ages
for
all c
hild
ren
Rang
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es fo
r cat
ch-u
p im
mun
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NO
TE: T
he a
bove
reco
mm
enda
tions
mus
t be
read
alo
ng w
ith th
e fo
otno
tes o
f thi
s sch
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This
sch
edul
e in
clud
es re
com
men
datio
ns in
effe
ct a
s of
Janu
ary
1, 2
014.
Any
dos
e no
t adm
inis
tere
d at
the
reco
mm
ende
d ag
e sh
ould
be
adm
inis
tere
d at
a s
ubse
quen
t vis
it, w
hen
indi
cate
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d fe
asib
le. T
he u
se o
f a c
ombi
natio
n va
ccin
e ge
nera
lly is
pre
ferr
ed o
ver s
epar
ate
inje
ctio
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f its
equ
ival
ent c
ompo
nent
vac
cine
s. Va
ccin
atio
n pr
ovid
ers
shou
ld c
onsu
lt th
e re
leva
nt A
dvis
ory
Com
mitt
ee o
n Im
mun
izat
ion
Prac
tices
(ACI
P) s
tate
men
t for
det
aile
d re
com
men
datio
ns, a
vaila
ble
onlin
e at
htt
p://
ww
w.c
dc.g
ov/v
acci
nes/
hcp/
acip
-rec
s/in
dex.
htm
l. Cl
inic
ally
sig
nific
ant a
dver
se e
vent
s th
at fo
llow
vac
cina
tion
shou
ld b
e re
port
ed to
the
Vacc
ine
Adve
rse
Even
t Rep
ortin
g Sy
stem
(V
AER
S) o
nlin
e (h
ttp:
//w
ww
.vae
rs.h
hs.g
ov) o
r by
tele
phon
e (8
00-8
22-7
967)
.Sus
pect
ed c
ases
of v
acci
ne-p
reve
ntab
le d
isea
ses
shou
ld b
e re
port
ed to
the
stat
e or
loca
l hea
lth d
epar
tmen
t. Ad
ditio
nal i
nfor
mat
ion,
incl
udin
g pr
ecau
tions
and
con
trai
ndic
atio
ns fo
r vac
cina
tion,
is a
vaila
ble
from
CD
C on
line
(htt
p://
ww
w.c
dc.g
ov/v
acci
nes)
or b
y te
leph
one
(800
-CD
C-IN
FO [8
00-2
32-4
636]
).
This
sch
edul
e is
app
rove
d by
the
Advi
sory
Com
mitt
ee o
n Im
mun
izat
ion
Prac
tices
(htt
p//w
ww
.cdc
.gov
/vac
cine
s/ac
ip),
the
Am
eric
an A
cade
my
of P
edia
tric
s (h
ttp:
//w
ww
.aap
.org
), th
e A
mer
ican
Aca
dem
y of
Fam
ily P
hysi
cian
s (h
ttp:
//w
ww
.aaf
p.or
g), a
nd th
e A
mer
ican
Col
lege
of O
bste
tric
ians
and
Gyn
ecol
ogis
ts (h
ttp:
//w
ww
.aco
g.or
g).
Rang
e of
reco
mm
ende
d ag
es
durin
g w
hich
cat
ch-u
p is
en
cour
aged
and
for c
erta
in
high
-ris
k gr
oups
Vacc
ines
Birt
h1
mo
2 m
os4
mos
6 m
os9
mos
12 m
os15
mos
18 m
os19
–23
mos
2-3
yrs
4-6
yrs
7-10
yrs
11-1
2 yr
s13
–15
yrs
16–1
8 yr
s
Hep
atiti
s B1 (
Hep
B)
Rota
viru
s2 (RV
) RV1
(2-d
ose
serie
s); R
V5 (3
-dos
e se
ries)
Dip
hthe
ria, t
etan
us, &
ace
l-lu
lar p
ertu
ssis3 (
DTa
P: <
7 yr
s)
Teta
nus,
diph
ther
ia, &
ace
l-lu
lar p
ertu
ssis4
(Tda
p: >
7 yr
s)
Hae
mop
hilu
s infl
uenz
ae ty
pe
b5 (H
ib)
Pneu
moc
occa
l con
juga
te6
(PCV
13)
Pneu
moc
occa
l pol
ysac
cha-
ride6 (
PPSV
23)
Inac
tivat
ed P
olio
viru
s7 (IP
V)
(<18
yrs
)
Influ
enza
8 (IIV
; LAI
V) 2
dos
es
for s
ome:
See
foot
note
8
Mea
sles,
mum
ps, r
ubel
la9
(MM
R)
Varic
ella
10 (V
AR)
Hep
atiti
s A11
(Hep
A)
Hum
an p
apill
omav
irus12
(H
PV2:
fem
ales
onl
y; H
PV4:
m
ales
and
fem
ales
)
Men
ingo
cocc
al13
(Hib
-Men
-CY
> 6
wee
ks; M
enAC
WY-
D
>9 m
os; M
enAC
WY-
CRM
≥
2 m
os)
Boos
ter
1st do
seSe
e fo
otno
te 1
3
(3-d
ose
serie
s)
2-do
se se
ries,
See
foot
note
11
2nd do
se1st
dose
2nd do
se1st
dose
Annu
al v
acci
natio
n (II
V or
LAI
V)An
nual
vac
cina
tion
(IIV
only
)
(Tda
p)
See
foot
note
22nd
dos
e1st
dose
4th d
ose
3rd d
ose
2nd d
ose
1st do
se
4th d
ose
3rd d
ose
2nd do
se1st
dose
3rd o
r 4th
dos
e,
See
foot
note
5Se
e fo
otno
te 5
2nd do
se1st
dose
5th d
ose
4th d
ose
3rd d
ose
2nd d
ose
1st do
se
3rd d
ose
2nd d
ose
1st do
se
148 Reference Range Values for Pediatric CareFI
GU
RE 2
. Cat
ch-u
p im
mun
izat
ion
sche
dule
for p
erso
ns a
ged
4 m
onth
s thr
ough
18
year
s who
star
t lat
e or
who
are
mor
e th
an 1
mon
th b
ehin
d —
Uni
ted
Stat
es, 2
014.
The
figur
e be
low
pro
vide
s cat
ch-u
p sc
hedu
les a
nd m
inim
um in
terv
als b
etw
een
dose
s for
chi
ldre
n w
hose
vac
cina
tions
hav
e be
en d
elay
ed. A
vac
cine
serie
s doe
s not
nee
d to
be
rest
arte
d, re
gard
less
of t
he ti
me
that
has
ela
psed
bet
wee
n do
ses.
Use
the
sect
ion
appr
opria
te fo
r the
chi
ld’s
age.
Alw
ays u
se th
is ta
ble
in c
onju
nctio
n w
ith F
igur
e 1
and
the
foot
note
s tha
t fol
low
.
Pers
ons
aged
4 m
onth
s th
roug
h 6
year
s
Vacc
ine
Min
imum
Ag
e fo
r D
ose
1
Min
imum
Inte
rval
Bet
wee
n D
oses
Dos
e 1
to d
ose
2D
ose
2 to
dos
e 3
Dos
e 3
to d
ose
4D
ose
4 to
dos
e 5
Hep
atiti
s B
1B
irth
4 w
eeks
8 w
eeks
and
at l
east
16
wee
ks a
fter fi
rst d
ose;
min
imum
age
fo
r the
fina
l dos
e is
24
wee
ks
Rot
aviru
s26
wee
ks4
wee
ks4
wee
ks
Dip
hthe
ria, t
etan
us, &
ac
ellu
lar p
ertu
ssis
36
wee
ks4
wee
ks4
wee
ks6
mon
ths
6 m
onth
s3
Hae
mop
hilu
s influenzae
type
b5
6 w
eeks
4 w
eeks
if fi
rst d
ose
adm
inis
tere
d at
you
nger
than
age
12
mon
ths
8 w
eeks
(as
final
dos
e)
if fir
st d
ose
adm
inis
tere
d at
age
12
thro
ugh
14 m
onth
sN
o fu
rther
dos
es n
eede
dif
first
dos
e ad
min
iste
red
at a
ge 1
5 m
onth
s or
old
er
4 w
eeks
5 if c
urre
nt a
ge is
you
nger
than
12
mon
ths
and
first
do
se a
dmin
iste
red
at <
7 m
onth
s ol
d8
wee
ks a
nd a
ge 1
2 m
onth
s th
roug
h 59
mon
ths
(as
final
do
se)5 i
f cur
rent
age
is y
oung
er th
an 1
2 m
onth
s an
d fir
st d
ose
adm
inis
tere
d be
twee
n 7
thro
ugh
11 m
onth
s (r
egar
dles
s of
Hib
va
ccin
e [P
RP
-T o
r PR
P-O
MP
] use
d fo
r firs
t dos
e); O
Rif
curr
ent a
ge is
12
thro
ugh
59 m
onth
s an
d fir
st d
ose
adm
inis
tere
d at
you
nger
than
age
12
mon
ths;
OR
first
2 d
oses
wer
e P
RP
-OM
P an
d ad
min
iste
red
at y
oung
er th
an
12 m
onth
s.
No
furth
er d
oses
nee
ded
if pr
evio
us d
ose
adm
inis
tere
d at
age
15
mon
ths
or o
lder
8 w
eeks
(as
final
dos
e)
This
dos
e on
ly n
eces
sary
for c
hild
ren
aged
12
thro
ugh
59 m
onth
s w
ho re
ceiv
ed 3
(PR
P-T
) dos
es b
efor
e ag
e 12
mon
ths
and
star
ted
the
prim
ary
serie
s be
fore
age
7
mon
ths
Pne
umoc
occa
l66
wee
ks
4 w
eeks
if fi
rst d
ose
adm
inis
tere
d at
you
nger
than
age
12
mon
ths
8 w
eeks
(as
final
dos
e fo
r hea
lthy
child
ren)
if fi
rst d
ose
adm
inis
tere
d at
age
12
mon
ths
or o
lder
N
o fu
rther
dos
es n
eede
d fo
r hea
lthy
child
ren
if fir
st d
ose
adm
inis
tere
d at
age
24
mon
ths
or o
lder
4 w
eeks
if c
urre
nt a
ge is
you
nger
than
12
mon
ths
8 w
eeks
(as
final
dos
e fo
r hea
lthy
child
ren)
if c
urre
nt a
ge is
12
mon
ths
or o
lder
No
furth
er d
oses
nee
ded
for h
ealth
y ch
ildre
n if
prev
ious
dos
e ad
min
iste
red
at a
ge 2
4 m
onth
s or
old
er
8 w
eeks
(as
final
dos
e)
This
dos
e on
ly n
eces
sary
for c
hild
ren
aged
12
thro
ugh
59 m
onth
s w
ho re
ceiv
ed 3
dos
es b
efor
e ag
e 12
m
onth
s or
for c
hild
ren
at h
igh
risk
who
rece
ived
3
dose
s at
any
age
Inac
tivat
ed p
olio
viru
s76
wee
ks4
wee
ks7
4 w
eeks
76
mon
ths7 m
inim
um a
ge 4
yea
rs fo
r fina
l dos
e
Men
ingo
cocc
al13
6 w
eeks
8 w
eeks
13S
ee fo
otno
te 1
3S
ee fo
otno
te 1
3
Mea
sles
, mum
ps,
rube
lla9
12
mon
ths
4 w
eeks
Varic
ella
1012
mon
ths
3 m
onth
s
Hep
atiti
s A
1112
mon
ths
6 m
onth
s
Pers
ons
aged
7 th
roug
h 18
yea
rs
Teta
nus,
dip
hthe
ria;
teta
nus,
dip
hthe
ria, &
ac
ellu
lar p
ertu
ssis
47
year
s44
wee
ks
4 w
eeks
if fi
rst d
ose
of D
TaP
/DT
adm
inis
tere
d at
you
nger
than
ag
e 12
mon
ths
6 m
onth
s if
first
dos
e of
DTa
P/D
T ad
min
iste
red
at a
ge 1
2 m
onth
s or
old
er a
nd th
en n
o fu
rther
dos
es n
eede
d fo
r cat
ch-u
p
6 m
onth
s if
first
dos
e of
DTa
P/D
T ad
min
iste
red
at
youn
ger t
han
age
12 m
onth
s
Hum
an p
apill
omav
irus12
9 ye
ars
Rou
tine
dosi
ng in
terv
als
are
reco
mm
ende
d12
Hep
atiti
s A
1112
mon
ths
6 m
onth
s
Hep
atiti
s B
1B
irth
4 w
eeks
8 w
eeks
(and
at l
east
16
wee
ks a
fter fi
rst d
ose)
Inac
tivat
ed p
olio
viru
s76
wee
ks4
wee
ks4
wee
ks7
6 m
onth
s7
Men
ingo
cocc
al13
6 w
eeks
8 w
eeks
13
Mea
sles
, mum
ps,
rube
lla9
12 m
onth
s4
wee
ks
Varic
ella
1012
m
onth
s3
mon
ths
if pe
rson
is y
oung
er th
an a
ge 1
3 ye
ars
4 w
eeks
if p
erso
n is
age
d 13
yea
rs o
r old
er
NO
TE: T
he a
bove
reco
mm
enda
tions
mus
t be
read
alo
ng w
ith th
e fo
otno
tes o
f thi
s sch
edul
e.
RECOMMENDED IMMUNIZATION SCHEDULE, continued
149Appendices
1.
Hep
atiti
s B
(Hep
B) v
acci
ne. (
Min
imum
age
: bir
th)
Rout
ine
vacc
inat
ion:
A
t bir
th•
Adm
inis
ter m
onov
alen
t Hep
B va
ccin
e to
all
new
born
s be
fore
hos
pita
l dis
char
ge.
•Fo
r inf
ants
bor
n to
hep
atiti
s B
surf
ace
antig
en (H
BsAg
)-pos
itive
mot
hers
, adm
inis
ter H
epB
vacc
ine
and
0.5
mL
of h
epat
itis
B im
mun
e gl
obul
in (H
BIG
) with
in 1
2 ho
urs
of b
irth.
The
se in
fant
s sh
ould
be
test
ed
for H
BsAg
and
ant
ibod
y to
HBs
Ag (a
nti-H
Bs) 1
to 2
mon
ths
afte
r com
plet
ion
of th
e H
epB
serie
s, at
age
9
thro
ugh
18 m
onth
s (p
refe
rabl
y at
the
next
wel
l-chi
ld v
isit)
. •
If m
othe
r’s H
BsAg
sta
tus
is u
nkno
wn,
with
in 1
2 ho
urs
of b
irth
adm
inis
ter H
epB
vacc
ine
rega
rdle
ss o
f bi
rth
wei
ght.
For i
nfan
ts w
eigh
ing
less
than
2,0
00 g
ram
s, ad
min
iste
r HBI
G in
add
ition
to H
epB
vacc
ine
with
in 1
2 ho
urs
of b
irth.
Det
erm
ine
mot
her’s
HBs
Ag s
tatu
s as
soo
n as
pos
sibl
e an
d, if
mot
her i
s H
BsAg
-po
sitiv
e, a
lso
adm
inis
ter H
BIG
for i
nfan
ts w
eigh
ing
2,00
0 gr
ams
or m
ore
as s
oon
as p
ossi
ble,
but
no
late
r tha
n ag
e 7
days
.D
oses
follo
win
g th
e bi
rth
dose
•Th
e se
cond
dos
e sh
ould
be
adm
inis
tere
d at
age
1 o
r 2 m
onth
s. M
onov
alen
t Hep
B va
ccin
e sh
ould
be
used
for d
oses
adm
inis
tere
d be
fore
age
6 w
eeks
.•
Infa
nts
who
did
not
rece
ive
a bi
rth
dose
sho
uld
rece
ive
3 do
ses
of a
Hep
B-co
ntai
ning
vac
cine
on
a sc
hedu
le o
f 0, 1
to 2
mon
ths,
and
6 m
onth
s st
artin
g as
soo
n as
feas
ible
. See
Fig
ure
2.•
Adm
inis
ter t
he s
econ
d do
se 1
to 2
mon
ths
afte
r the
firs
t dos
e (m
inim
um in
terv
al o
f 4 w
eeks
), ad
min
iste
r the
third
dos
e at
leas
t 8 w
eeks
aft
er th
e se
cond
dos
e A
ND
at l
east
16
wee
ks a
fter
the
first
do
se. T
he fi
nal (
third
or f
ourt
h) d
ose
in th
e H
epB
vacc
ine
serie
s sh
ould
be
adm
inis
tere
d no
ear
lier t
han
age
24 w
eeks
. •
Adm
inis
trat
ion
of a
tota
l of 4
dos
es o
f Hep
B va
ccin
e is
per
mitt
ed w
hen
a co
mbi
natio
n va
ccin
e co
ntai
ning
Hep
B is
adm
inis
tere
d af
ter t
he b
irth
dose
. Ca
tch-
up v
acci
nati
on:
•U
nvac
cina
ted
pers
ons
shou
ld c
ompl
ete
a 3-
dose
ser
ies.
•A
2-d
ose
serie
s (d
oses
sep
arat
ed b
y at
leas
t 4 m
onth
s) o
f adu
lt fo
rmul
atio
n Re
com
biva
x H
B is
lice
nsed
fo
r use
in c
hild
ren
aged
11
thro
ugh
15 y
ears
. •
For o
ther
cat
ch-u
p gu
idan
ce, s
ee F
igur
e 2.
2.
Rota
viru
s (R
V) v
acci
nes.
(Min
imum
age
: 6 w
eeks
for b
oth
RV1
[Rot
arix
] and
RV5
[Rot
aTeq
])Ro
utin
e va
ccin
atio
n:Ad
min
iste
r a s
erie
s of
RV
vacc
ine
to a
ll in
fant
s as
follo
ws:
1.
If R
otar
ix is
use
d, a
dmin
iste
r a 2
-dos
e se
ries
at 2
and
4 m
onth
s of
age
. 2.
If R
otaT
eq is
use
d, a
dmin
iste
r a 3
-dos
e se
ries
at a
ges
2, 4
, and
6 m
onth
s. 3.
If a
ny d
ose
in th
e se
ries w
as R
otaT
eq o
r vac
cine
pro
duct
is u
nkno
wn
for a
ny d
ose
in th
e se
ries,
a to
tal
of 3
dos
es o
f RV
vacc
ine
shou
ld b
e ad
min
iste
red.
Ca
tch-
up v
acci
nati
on:
•Th
e m
axim
um a
ge fo
r the
firs
t dos
e in
the
serie
s is
14
wee
ks, 6
day
s; v
acci
natio
n sh
ould
not
be
initi
ated
for i
nfan
ts a
ged
15 w
eeks
, 0 d
ays
or o
lder
.•
The
max
imum
age
for t
he fi
nal d
ose
in th
e se
ries
is 8
mon
ths,
0 da
ys.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2.
3.
Dip
hthe
ria
and
teta
nus
toxo
ids
and
acel
lula
r per
tuss
is (D
TaP)
vac
cine
. (M
inim
um a
ge: 6
wee
ks.
Exce
ptio
n: D
TaP-
IPV
[Kin
rix]
: 4 y
ears
)Ro
utin
e va
ccin
atio
n:•
Adm
inis
ter a
5-d
ose
serie
s of D
TaP
vacc
ine
at a
ges 2
, 4, 6
, 15
thro
ugh
18 m
onth
s, an
d 4
thro
ugh
6 ye
ars.
The
four
th d
ose
may
be
adm
inis
tere
d as
ear
ly a
s age
12
mon
ths,
prov
ided
at l
east
6 m
onth
s hav
e el
apse
d si
nce
the
third
dos
e.Ca
tch-
up v
acci
nati
on:
•Th
e fif
th d
ose
of D
TaP
vacc
ine
is n
ot n
eces
sary
if th
e fo
urth
dos
e w
as a
dmin
iste
red
at a
ge 4
yea
rs o
r old
er.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2.4.
Te
tanu
s an
d di
phth
eria
toxo
ids
and
acel
lula
r per
tuss
is (T
dap)
vac
cine
. (M
inim
um a
ge: 1
0 ye
ars
for
Boos
trix
, 11
year
s fo
r Ada
cel)
Rout
ine
vacc
inat
ion:
•
Adm
inis
ter 1
dos
e of
Tdap
vac
cine
to a
ll ad
oles
cent
s ag
ed 1
1 th
roug
h 12
yea
rs.
•Td
ap m
ay b
e ad
min
ister
ed re
gard
less
of t
he in
terv
al si
nce
the
last
teta
nus a
nd d
ipht
heria
toxo
id-c
onta
inin
g va
ccin
e.•
Adm
inis
ter 1
dos
e of
Tdap
vac
cine
to p
regn
ant a
dole
scen
ts d
urin
g ea
ch p
regn
ancy
(pre
ferr
ed d
urin
g 27
thro
ugh
36 w
eeks
ges
tatio
n) re
gard
less
of t
ime
sinc
e pr
ior T
d or
Tdap
vac
cina
tion.
Ca
tch-
up v
acci
nati
on:
•Pe
rson
s ag
ed 7
yea
rs a
nd o
lder
who
are
not
fully
imm
uniz
ed w
ith D
TaP
vacc
ine
shou
ld re
ceiv
e Td
ap
vacc
ine
as 1
(pre
fera
bly
the
first
) dos
e in
the
catc
h-up
ser
ies;
if a
dditi
onal
dos
es a
re n
eede
d, u
se Td
va
ccin
e. F
or c
hild
ren
7 th
roug
h 10
yea
rs w
ho re
ceiv
e a
dose
of T
dap
as p
art o
f the
cat
ch-u
p se
ries,
an
adol
esce
nt Td
ap v
acci
ne d
ose
at a
ge 1
1 th
roug
h 12
yea
rs s
houl
d N
OT
be a
dmin
iste
red.
Td s
houl
d be
ad
min
iste
red
inst
ead
10 y
ears
aft
er th
e Td
ap d
ose.
•Pe
rson
s ag
ed 1
1 th
roug
h 18
yea
rs w
ho h
ave
not r
ecei
ved
Tdap
vac
cine
sho
uld
rece
ive
a do
se fo
llow
ed
by te
tanu
s an
d di
phth
eria
toxo
ids
(Td)
boo
ster
dos
es e
very
10
year
s th
erea
fter
.•
Inad
vert
ent d
oses
of D
TaP
vacc
ine:
-If
adm
inis
tere
d in
adve
rten
tly to
a c
hild
age
d 7
thro
ugh
10 y
ears
may
cou
nt a
s pa
rt o
f the
cat
ch-u
p se
ries.
This
dos
e m
ay c
ount
as
the
adol
esce
nt Td
ap d
ose,
or t
he c
hild
can
late
r rec
eive
a Td
ap
boos
ter d
ose
at a
ge 1
1 th
roug
h 12
yea
rs.
-If
adm
inis
tere
d in
adve
rten
tly to
an
adol
esce
nt a
ged
11 th
roug
h 18
yea
rs, t
he d
ose
shou
ld b
e co
unte
d as
the
adol
esce
nt Td
ap b
oost
er.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2.5.
H
aem
ophi
lus i
nflue
nzae
type
b (H
ib) c
onju
gate
vac
cine
. (M
inim
um a
ge:
6 w
eeks
for P
RP-T
[ACT
HIB
, D
TaP-
IPV/
Hib
(Pen
tace
l) an
d H
ib-M
enCY
(Men
Hib
rix)
], PR
P-O
MP
[Ped
vaxH
IB o
r CO
MVA
X], 1
2 m
onth
s fo
r PRP
-T [H
iber
ix])
Rout
ine
vacc
inat
ion:
•Ad
min
iste
r a 2
- or 3
-dos
e H
ib v
acci
ne p
rimar
y se
ries
and
a bo
oste
r dos
e (d
ose
3 or
4 d
epen
ding
on
vacc
ine
used
in p
rimar
y se
ries)
at a
ge 1
2 th
roug
h 15
mon
ths
to c
ompl
ete
a fu
ll H
ib v
acci
ne s
erie
s.•
The
prim
ary
serie
s w
ith A
ctH
IB, M
enH
ibrix
, or P
enta
cel c
onsi
sts
of 3
dos
es a
nd s
houl
d be
adm
inis
tere
d at
2, 4
, and
6 m
onth
s of
age
. The
prim
ary
serie
s w
ith P
edva
xHib
or C
OM
VAX
cons
ists
of 2
dos
es a
nd
shou
ld b
e ad
min
iste
red
at 2
and
4 m
onth
s of
age
; a d
ose
at a
ge 6
mon
ths
is n
ot in
dica
ted.
•O
ne b
oost
er d
ose
(dos
e 3
or 4
dep
endi
ng o
n va
ccin
e us
ed in
prim
ary
serie
s) o
f any
Hib
vac
cine
sho
uld
be a
dmin
iste
red
at a
ge 1
2 th
roug
h 15
mon
ths.
An
exce
ptio
n is
Hib
erix
vac
cine
. Hib
erix
sho
uld
only
be
use
d fo
r the
boo
ster
(fina
l) do
se in
chi
ldre
n ag
ed 1
2 m
onth
s th
roug
h 4
year
s w
ho h
ave
rece
ived
at
leas
t 1 p
rior d
ose
of H
ib-c
onta
inin
g va
ccin
e.
Foot
note
s — R
ecom
men
ded
imm
uniz
atio
n sc
hedu
le fo
r per
sons
age
d 0
thro
ugh
18 y
ears
—U
nite
d St
ates
, 201
4
For f
urth
er g
uida
nce
on th
e us
e of
the
vacc
ines
men
tione
d be
low
, see
: htt
p://
ww
w.c
dc.g
ov/v
acci
nes/
hcp/
acip
-rec
s/in
dex.
htm
l. Fo
r vac
cine
reco
mm
enda
tions
for p
erso
ns 1
9 ye
ars
of a
ge a
nd o
lder
, see
the
adul
t im
mun
izat
ion
sche
dule
.A
dditi
onal
info
rmat
ion
•Fo
r con
trai
ndic
atio
ns a
nd p
reca
utio
ns to
use
of a
vac
cine
and
for a
dditi
onal
info
rmat
ion
rega
rdin
g th
at v
acci
ne, v
acci
natio
n pr
ovid
ers
shou
ld c
onsu
lt th
e re
leva
nt A
CIP
stat
emen
t ava
ilabl
e on
line
at h
ttp:
//w
ww
.cdc
.gov
/vac
cine
s/hc
p/ac
ip-r
ecs/
inde
x.ht
ml.
•Fo
r pur
pose
s of
cal
cula
ting
inte
rval
s be
twee
n do
ses,
4 w
eeks
= 2
8 da
ys. I
nter
vals
of 4
mon
ths
or g
reat
er a
re d
eter
min
ed b
y ca
lend
ar m
onth
s. •
Vacc
ine
dose
s ad
min
iste
red
4 da
ys o
r les
s be
fore
the
min
imum
inte
rval
are
con
side
red
valid
. Dos
es o
f any
vac
cine
adm
inis
tere
d ≥5
day
s ea
rlier
than
the
min
imum
inte
rval
or m
inim
um a
ge
shou
ld n
ot b
e co
unte
d as
val
id d
oses
and
sho
uld
be re
peat
ed a
s ag
e-ap
prop
riate
. The
repe
at d
ose
shou
ld b
e sp
aced
aft
er th
e in
valid
dos
e by
the
reco
mm
ende
d m
inim
um in
terv
al. F
or fu
rthe
r de
tails
, see
MM
WR,
Gen
eral
Rec
omm
enda
tions
on
Imm
uniz
atio
n an
d Re
port
s / V
ol. 6
0 / N
o. 2
; Tab
le 2
. Rec
omm
ende
d an
d m
inim
um a
ges a
nd in
terv
als b
etw
een
vacc
ine
dose
s ava
ilabl
e on
line
at
http
://w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r600
2.pd
f.•
Info
rmat
ion
on tr
avel
vac
cine
requ
irem
ents
and
reco
mm
enda
tions
is a
vaila
ble
at h
ttp:
//w
ww
nc.c
dc.g
ov/t
rave
l/pag
e/va
ccin
atio
ns.h
tm.
•Fo
r vac
cina
tion
of p
erso
ns w
ith p
rimar
y an
d se
cond
ary
imm
unod
efici
enci
es, s
ee T
able
13,
“Vac
cina
tion
of p
erso
ns w
ith p
rimar
y an
d se
cond
ary
imm
unod
efici
enci
es,” i
n G
ener
al R
ecom
men
datio
ns
on Im
mun
izat
ion
(ACI
P), a
vaila
ble
at h
ttp:
//w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r600
2.pd
f.; a
nd A
mer
ican
Aca
dem
y of
Ped
iatr
ics.
Imm
uniz
atio
n in
Spe
cial
Clin
ical
Circ
umst
ance
s, in
Pic
kerin
g LK
, Bak
er C
J, Ki
mbe
rlin
DW
, Lon
g SS
eds
. Red
Boo
k: 2
012
repo
rt o
f the
Com
mitt
ee o
n In
fect
ious
Dis
ease
s. 29
th e
d. E
lk G
rove
Vill
age,
IL: A
mer
ican
Aca
dem
y of
Ped
iatr
ics.
150 Reference Range Values for Pediatric CareFo
r fur
ther
gui
danc
e on
the
use
of th
e va
ccin
es m
entio
ned
belo
w, s
ee: h
ttp:
//w
ww
.cdc
.gov
/vac
cine
s/hc
p/ac
ip-r
ecs/
inde
x.ht
ml.
5.
Hae
mop
hilu
s infl
uenz
ae ty
pe b
(Hib
) con
juga
te v
acci
ne (c
ont’d
)•
For r
ecom
men
datio
ns o
n th
e us
e of
Men
Hib
rix in
pat
ient
s at
incr
ease
d ris
k fo
r men
ingo
cocc
al d
isea
se,
plea
se re
fer t
o th
e m
enin
goco
ccal
vac
cine
foot
note
s an
d al
so to
MM
WR
Mar
ch 2
2, 2
013
/ 62(
RR02
); 1-
22, a
vaila
ble
at h
ttp:
//w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r620
2.pd
f.
Catc
h-up
vac
cina
tion
:•
If do
se 1
was
adm
inis
tere
d at
age
s 12
thro
ugh
14 m
onth
s, ad
min
iste
r a s
econ
d (fi
nal)
dose
at l
east
8
wee
ks a
fter
dos
e 1,
rega
rdle
ss o
f Hib
vac
cine
use
d in
the
prim
ary
serie
s.•
If th
e fir
st 2
dos
es w
ere
PRP-
OM
P (P
edva
xHIB
or C
OM
VAX)
, and
wer
e ad
min
iste
red
at a
ge 1
1 m
onth
s or
yo
unge
r, th
e th
ird (a
nd fi
nal)
dose
sho
uld
be a
dmin
iste
red
at a
ge 1
2 th
roug
h 15
mon
ths
and
at le
ast 8
w
eeks
aft
er th
e se
cond
dos
e.•
If th
e fir
st d
ose
was
adm
inis
tere
d at
age
7 th
roug
h 11
mon
ths,
adm
inis
ter t
he s
econ
d do
se a
t lea
st 4
w
eeks
late
r and
a th
ird (a
nd fi
nal)
dose
at a
ge 1
2 th
roug
h 15
mon
ths
or 8
wee
ks a
fter
sec
ond
dose
, w
hich
ever
is la
ter,
rega
rdle
ss o
f Hib
vac
cine
use
d fo
r firs
t dos
e.
•If
first
dos
e is
adm
inis
tere
d at
you
nger
than
12
mon
ths
of a
ge a
nd s
econ
d do
se is
giv
en b
etw
een
12
thro
ugh
14 m
onth
s of
age
, a th
ird (a
nd fi
nal)
dose
sho
uld
be g
iven
8 w
eeks
late
r.•
For u
nvac
cina
ted
child
ren
aged
15
mon
ths
or o
lder
, adm
inis
ter o
nly
1 do
se.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2. F
or c
atch
-up
guid
ance
rela
ted
to M
enH
ibrix
, ple
ase
see
the
men
ingo
cocc
al v
acci
ne fo
otno
tes
and
also
MM
WR
Mar
ch 2
2, 2
013
/ 62(
RR02
); 1-
22, a
vaila
ble
at h
ttp:
//w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r620
2.pd
f.Va
ccin
atio
n of
per
sons
wit
h hi
gh-r
isk
cond
itio
ns:
•Ch
ildre
n ag
ed 1
2 th
roug
h 59
mon
ths
who
are
at i
ncre
ased
risk
for H
ib d
isea
se, i
nclu
ding
ch
emot
hera
py re
cipi
ents
and
thos
e w
ith a
nato
mic
or f
unct
iona
l asp
leni
a (in
clud
ing
sick
le c
ell d
isea
se),
hum
an im
mun
odefi
cien
cy v
irus
(HIV
) inf
ectio
n, im
mun
oglo
bulin
defi
cien
cy, o
r ear
ly c
ompo
nent
co
mpl
emen
t defi
cien
cy, w
ho h
ave
rece
ived
eith
er n
o do
ses
or o
nly
1 do
se o
f Hib
vac
cine
bef
ore
12
mon
ths
of a
ge, s
houl
d re
ceiv
e 2
addi
tiona
l dos
es o
f Hib
vac
cine
8 w
eeks
apa
rt; c
hild
ren
who
rece
ived
2
or m
ore
dose
s of
Hib
vac
cine
bef
ore
12 m
onth
s of
age
sho
uld
rece
ive
1 ad
ditio
nal d
ose.
•Fo
r pat
ient
s yo
unge
r tha
n 5
year
s of
age
und
ergo
ing
chem
othe
rapy
or r
adia
tion
trea
tmen
t who
re
ceiv
ed a
Hib
vac
cine
dos
e(s)
with
in 1
4 da
ys o
f sta
rtin
g th
erap
y or
dur
ing
ther
apy,
repe
at th
e do
se(s
) at
leas
t 3 m
onth
s fo
llow
ing
ther
apy
com
plet
ion.
•Re
cipi
ents
of h
emat
opoi
etic
ste
m c
ell t
rans
plan
t (H
SCT)
sho
uld
be re
vacc
inat
ed w
ith a
3-d
ose
regi
men
of
Hib
vac
cine
sta
rtin
g 6
to 1
2 m
onth
s af
ter s
ucce
ssfu
l tra
nspl
ant,
rega
rdle
ss o
f vac
cina
tion
hist
ory;
do
ses
shou
ld b
e ad
min
iste
red
at le
ast 4
wee
ks a
part
.•
A s
ingl
e do
se o
f any
Hib
-con
tain
ing
vacc
ine
shou
ld b
e ad
min
iste
red
to u
nim
mun
ized
* ch
ildre
n an
d ad
oles
cent
s 15
mon
ths
of a
ge a
nd o
lder
und
ergo
ing
an e
lect
ive
sple
nect
omy;
if p
ossi
ble,
vac
cine
sh
ould
be
adm
inis
tere
d at
leas
t 14
days
bef
ore
proc
edur
e.•
Hib
vac
cine
is n
ot ro
utin
ely
reco
mm
ende
d fo
r pat
ient
s 5
year
s or
old
er. H
owev
er, 1
dos
e of
Hib
vac
cine
sh
ould
be
adm
inis
tere
d to
uni
mm
uniz
ed*
pers
ons
aged
5 y
ears
or o
lder
who
hav
e an
atom
ic o
r fu
nctio
nal a
sple
nia
(incl
udin
g si
ckle
cel
l dis
ease
) and
unv
acci
nate
d pe
rson
s 5
thro
ugh
18 y
ears
of a
ge
with
hum
an im
mun
odefi
cien
cy v
irus
(HIV
) inf
ectio
n.
* Pa
tient
s who
hav
e no
t rec
eive
d a
prim
ary
serie
s and
boo
ster
dos
e or
at l
east
1 d
ose
of H
ib v
acci
ne
afte
r 14
mon
ths o
f age
are
con
side
red
unim
mun
ized
. 6.
Pn
eum
ococ
cal v
acci
nes.
(Min
imum
age
: 6 w
eeks
for P
CV13
, 2 y
ears
for P
PSV2
3)Ro
utin
e va
ccin
atio
n w
ith
PCV
13:
•Ad
min
iste
r a 4
-dos
e se
ries o
f PCV
13 v
acci
ne a
t age
s 2, 4
, and
6 m
onth
s and
at a
ge 1
2 th
roug
h 15
mon
ths.
•Fo
r chi
ldre
n ag
ed 1
4 th
roug
h 59
mon
ths
who
hav
e re
ceiv
ed a
n ag
e-ap
prop
riate
ser
ies
of 7
-val
ent P
CV
(PCV
7), a
dmin
iste
r a s
ingl
e su
pple
men
tal d
ose
of 1
3-va
lent
PCV
(PCV
13).
Catc
h-up
vac
cina
tion
wit
h PC
V13
:•
Adm
inis
ter 1
dos
e of
PCV
13 to
all
heal
thy
child
ren
aged
24
thro
ugh
59 m
onth
s w
ho a
re n
ot
com
plet
ely
vacc
inat
ed fo
r the
ir ag
e.•
For o
ther
cat
ch-u
p gu
idan
ce, s
ee F
igur
e 2.
Va
ccin
atio
n of
per
sons
wit
h hi
gh-r
isk
cond
itio
ns w
ith
PCV
13 a
nd P
PSV
23:
•A
ll re
com
men
ded
PCV1
3 do
ses
shou
ld b
e ad
min
iste
red
prio
r to
PPSV
23 v
acci
natio
n if
poss
ible
.•
For c
hild
ren
2 th
roug
h 5
year
s of
age
with
any
of t
he fo
llow
ing
cond
ition
s: c
hron
ic h
eart
dis
ease
(p
artic
ular
ly c
yano
tic c
onge
nita
l hea
rt d
isea
se a
nd c
ardi
ac fa
ilure
); ch
roni
c lu
ng d
isea
se (i
nclu
ding
as
thm
a if
trea
ted
with
hig
h-do
se o
ral c
ortic
oste
roid
ther
apy)
; dia
bete
s m
ellit
us; c
ereb
rosp
inal
flui
d le
ak; c
ochl
ear i
mpl
ant;
sick
le c
ell d
isea
se a
nd o
ther
hem
oglo
bino
path
ies;
ana
tom
ic o
r fun
ctio
nal
aspl
enia
; HIV
infe
ctio
n; c
hron
ic re
nal f
ailu
re; n
ephr
otic
syn
drom
e; d
isea
ses
asso
ciat
ed w
ith tr
eatm
ent
with
imm
unos
uppr
essi
ve d
rugs
or r
adia
tion
ther
apy,
incl
udin
g m
alig
nant
neo
plas
ms,
leuk
emia
s, ly
mph
omas
, and
Hod
gkin
dis
ease
; sol
id o
rgan
tran
spla
ntat
ion;
or c
onge
nita
l im
mun
odefi
cien
cy:
1. A
dmin
iste
r 1 d
ose
of P
CV13
if 3
dos
es o
f PCV
(PCV
7 an
d/or
PCV
13) w
ere
rece
ived
pre
viou
sly.
2. A
dmin
iste
r 2 d
oses
of P
CV13
at l
east
8 w
eeks
apa
rt if
few
er th
an 3
dos
es o
f PCV
(PCV
7 an
d/or
PCV
13)
wer
e re
ceiv
ed p
revi
ousl
y.
6.
Pneu
moc
occa
l vac
cine
s (c
ont’d
)3.
Adm
inis
ter 1
supp
lem
enta
l dos
e of
PCV
13 if
4 d
oses
of P
CV7
or o
ther
age
-app
ropr
iate
com
plet
e PC
V7
serie
s w
as re
ceiv
ed p
revi
ousl
y.4.
The
min
imum
inte
rval
bet
wee
n do
ses
of P
CV (P
CV7
or P
CV13
) is
8 w
eeks
.5.
For
chi
ldre
n w
ith n
o hi
stor
y of
PPS
V23
vacc
inat
ion,
adm
inis
ter P
PSV2
3 at
leas
t 8 w
eeks
aft
er th
e m
ost
rece
nt d
ose
of P
CV13
. •
For c
hild
ren
aged
6 th
roug
h 18
yea
rs w
ho h
ave
cere
bros
pina
l flui
d le
ak; c
ochl
ear i
mpl
ant;
sickl
e ce
ll dise
ase
and
othe
r hem
oglo
bino
path
ies;
anat
omic
or f
unct
iona
l asp
leni
a; co
ngen
ital o
r acq
uire
d im
mun
odefi
cien
cies
; H
IV in
fect
ion;
chro
nic r
enal
failu
re; n
ephr
otic
synd
rom
e; d
iseas
es a
ssoc
iate
d w
ith tr
eatm
ent w
ith
imm
unos
uppr
essiv
e dr
ugs o
r rad
iatio
n th
erap
y, in
clud
ing
mal
igna
nt n
eopl
asm
s, le
ukem
ias,
lym
phom
as, a
nd
Hod
gkin
dise
ase;
gen
eral
ized
mal
igna
ncy;
solid
org
an tr
ansp
lant
atio
n; o
r mul
tiple
mye
lom
a:1.
If n
eith
er P
CV13
nor
PPS
V23
has
been
rece
ived
pre
viou
sly,
adm
inis
ter
1 do
se o
f PCV
13 n
ow a
nd 1
do
se o
f PPS
V23
at le
ast 8
wee
ks la
ter.
2. I
f PCV
13 h
as b
een
rece
ived
pre
viou
sly
but
PPSV
23 h
as n
ot, a
dmin
iste
r 1
dose
of P
PSV2
3 at
leas
t 8
wee
ks a
fter
the
mos
t rec
ent d
ose
of P
CV13
. 3.
If P
PSV2
3 ha
s bee
n re
ceiv
ed b
ut P
CV13
has
not
, adm
inis
ter 1
dos
e of
PCV
13 a
t lea
st 8
wee
ks a
fter
the
mos
t rec
ent d
ose
of P
PSV2
3.•
For c
hild
ren
aged
6 th
roug
h 18
yea
rs w
ith c
hron
ic h
eart
dis
ease
(par
ticul
arly
cya
notic
con
geni
tal h
eart
di
seas
e an
d ca
rdia
c fa
ilure
), ch
roni
c lu
ng d
isea
se (i
nclu
ding
ast
hma
if tr
eate
d w
ith h
igh-
dose
ora
l co
rtic
oste
roid
ther
apy)
, dia
bete
s m
ellit
us, a
lcoh
olis
m, o
r chr
onic
live
r dis
ease
, who
hav
e no
t rec
eive
d PP
SV23
, adm
inis
ter 1
dos
e of
PPS
V23.
If P
CV13
has
bee
n re
ceiv
ed p
revi
ousl
y, th
en P
PSV2
3 sh
ould
be
adm
inis
tere
d at
leas
t 8 w
eeks
aft
er a
ny p
rior P
CV13
dos
e.•
A s
ingl
e re
vacc
inat
ion
with
PPS
V23
shou
ld b
e ad
min
iste
red
5 ye
ars
afte
r the
firs
t dos
e to
chi
ldre
n w
ith s
ickl
e ce
ll di
seas
e or
oth
er h
emog
lobi
nopa
thie
s; a
nato
mic
or f
unct
iona
l asp
leni
a; c
onge
nita
l or
acq
uire
d im
mun
odefi
cien
cies
; HIV
infe
ctio
n; c
hron
ic re
nal f
ailu
re; n
ephr
otic
syn
drom
e; d
isea
ses
asso
ciat
ed w
ith tr
eatm
ent w
ith im
mun
osup
pres
sive
dru
gs o
r rad
iatio
n th
erap
y, in
clud
ing
mal
igna
nt
neop
lasm
s, le
ukem
ias,
lym
phom
as, a
nd H
odgk
in d
isea
se; g
ener
aliz
ed m
alig
nanc
y; s
olid
org
an
tran
spla
ntat
ion;
or m
ultip
le m
yelo
ma.
7.
Inac
tivat
ed p
olio
viru
s va
ccin
e (IP
V).
(Min
imum
age
: 6 w
eeks
)Ro
utin
e va
ccin
atio
n:•
Adm
inis
ter a
4-d
ose
serie
s of
IPV
at a
ges
2, 4
, 6 th
roug
h 18
mon
ths,
and
4 th
roug
h 6
year
s. Th
e fin
al
dose
in th
e se
ries
shou
ld b
e ad
min
iste
red
on o
r aft
er th
e fo
urth
birt
hday
and
at l
east
6 m
onth
s af
ter
the
prev
ious
dos
e.Ca
tch-
up v
acci
nati
on:
•In
the
first
6 m
onth
s of l
ife, m
inim
um a
ge a
nd m
inim
um in
terv
als a
re o
nly
reco
mm
ende
d if
the
pers
on is
at r
isk
for i
mm
inen
t exp
osur
e to
circ
ulat
ing
polio
viru
s (i.e
., tra
vel t
o a
polio
-end
emic
regi
on o
r dur
ing
an o
utbr
eak)
. •
If 4
or m
ore
dose
s ar
e ad
min
iste
red
befo
re a
ge 4
yea
rs, a
n ad
ditio
nal d
ose
shou
ld b
e ad
min
iste
red
at
age
4 th
roug
h 6
year
s an
d at
leas
t 6 m
onth
s af
ter t
he p
revi
ous
dose
.•
A fo
urth
dos
e is
not
nec
essa
ry if
the
third
dos
e w
as a
dmin
iste
red
at a
ge 4
yea
rs o
r old
er a
nd a
t lea
st 6
m
onth
s af
ter t
he p
revi
ous
dose
. •
If bo
th O
PV a
nd IP
V w
ere
adm
inist
ered
as p
art o
f a se
ries,
a to
tal o
f 4 d
oses
shou
ld b
e ad
min
ister
ed, r
egar
dles
s of
the
child
’s cu
rrent
age
. IPV
is no
t rou
tinel
y re
com
men
ded
for U
.S. r
esid
ents
age
d 18
yea
rs o
r old
er.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2.8.
In
fluen
za v
acci
nes.
(Min
imum
age
: 6 m
onth
s fo
r ina
ctiv
ated
influ
enza
vac
cine
[IIV
], 2
year
s fo
r liv
e,
atte
nuat
ed in
fluen
za v
acci
ne [L
AIV
]) Ro
utin
e va
ccin
atio
n:•
Adm
inis
ter i
nflue
nza
vacc
ine
annu
ally
to a
ll ch
ildre
n be
ginn
ing
at a
ge 6
mon
ths.
For m
ost h
ealth
y,
nonp
regn
ant p
erso
ns a
ged
2 th
roug
h 49
yea
rs, e
ither
LA
IV o
r IIV
may
be
used
. How
ever
, LA
IV sh
ould
N
OT
be a
dmin
iste
red
to so
me
pers
ons,
incl
udin
g 1)
thos
e w
ith a
sthm
a, 2
) chi
ldre
n 2
thro
ugh
4 ye
ars w
ho
had
whe
ezin
g in
the
past
12
mon
ths,
or 3
) tho
se w
ho h
ave
any
othe
r und
erly
ing
med
ical
con
ditio
ns th
at
pred
ispo
se th
em to
influ
enza
com
plic
atio
ns. F
or a
ll ot
her c
ontr
aind
icat
ions
to u
se o
f LA
IV, s
ee M
MW
R 20
13; 6
2 (N
o. R
R-7)
:1-4
3, a
vaila
ble
at http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf
. Fo
r chi
ldre
n ag
ed 6
mon
ths
thro
ugh
8 ye
ars:
•Fo
r the
201
3–14
sea
son,
adm
inis
ter 2
dos
es (s
epar
ated
by
at le
ast 4
wee
ks) t
o ch
ildre
n w
ho a
re
rece
ivin
g in
fluen
za v
acci
ne fo
r the
firs
t tim
e. S
ome
child
ren
in th
is a
ge g
roup
who
hav
e be
en
vacc
inat
ed p
revi
ousl
y w
ill a
lso
need
2 d
oses
. For
add
ition
al g
uida
nce,
follo
w d
osin
g gu
idel
ines
in th
e 20
13-1
4 AC
IP in
fluen
za v
acci
ne re
com
men
datio
ns, M
MW
R 20
13; 6
2 (N
o. R
R-7)
:1-4
3, a
vaila
ble
at
http
://w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r620
7.pd
f. •
For t
he 2
014–
15 s
easo
n, fo
llow
dos
ing
guid
elin
es in
the
2014
ACI
P in
fluen
za v
acci
ne
reco
mm
enda
tions
. Fo
r per
sons
age
d 9
year
s an
d ol
der:
•Ad
min
iste
r 1 d
ose.
RECOMMENDED IMMUNIZATION SCHEDULE, continued
151Appendices
9.
Mea
sles
, mum
ps, a
nd ru
bella
(MM
R) v
acci
ne. (
Min
imum
age
: 12
mon
ths
for r
outin
e va
ccin
atio
n)Ro
utin
e va
ccin
atio
n:•
Adm
inist
er a
2-d
ose
serie
s of M
MR
vacc
ine
at a
ges1
2 th
roug
h 15
mon
ths a
nd 4
thro
ugh
6 ye
ars.
The
seco
nd
dose
may
be
adm
inist
ered
bef
ore
age
4 ye
ars,
prov
ided
at l
east
4 w
eeks
hav
e el
apse
d sin
ce th
e fir
st d
ose.
•
Adm
inis
ter 1
dos
e of
MM
R va
ccin
e to
infa
nts
aged
6 th
roug
h 11
mon
ths
befo
re d
epar
ture
from
the
Uni
ted
Stat
es fo
r int
erna
tiona
l tra
vel.
Thes
e ch
ildre
n sh
ould
be
reva
ccin
ated
with
2 d
oses
of M
MR
vacc
ine,
the
first
at a
ge 1
2 th
roug
h 15
mon
ths
(12
mon
ths
if th
e ch
ild re
mai
ns in
an
area
whe
re d
isea
se
risk
is h
igh)
, and
the
seco
nd d
ose
at le
ast 4
wee
ks la
ter.
•Ad
min
iste
r 2 d
oses
of M
MR
vacc
ine
to c
hild
ren
aged
12
mon
ths
and
olde
r bef
ore
depa
rtur
e fr
om th
e U
nite
d St
ates
for i
nter
natio
nal t
rave
l. Th
e fir
st d
ose
shou
ld b
e ad
min
iste
red
on o
r aft
er a
ge 1
2 m
onth
s an
d th
e se
cond
dos
e at
leas
t 4 w
eeks
late
r.Ca
tch-
up v
acci
nati
on:
•En
sure
that
all
scho
ol-a
ged
child
ren
and
adol
esce
nts
have
had
2 d
oses
of M
MR
vacc
ine;
the
min
imum
in
terv
al b
etw
een
the
2 do
ses
is 4
wee
ks.
10.
Vari
cella
(VA
R) v
acci
ne. (
Min
imum
age
: 12
mon
ths)
Ro
utin
e va
ccin
atio
n:•
Adm
inis
ter a
2-d
ose
serie
s of
VA
R va
ccin
e at
age
s 12
thro
ugh
15 m
onth
s an
d 4
thro
ugh
6 ye
ars.
The
seco
nd d
ose
may
be
adm
inis
tere
d be
fore
age
4 y
ears
, pro
vide
d at
leas
t 3 m
onth
s ha
ve e
laps
ed s
ince
th
e fir
st d
ose.
If th
e se
cond
dos
e w
as a
dmin
iste
red
at le
ast 4
wee
ks a
fter
the
first
dos
e, it
can
be
acce
pted
as
valid
.Ca
tch-
up v
acci
nati
on:
•En
sure
that
all
pers
ons
aged
7 th
roug
h 18
yea
rs w
ithou
t evi
denc
e of
imm
unity
(see
MM
WR
2007
; 56
[No.
RR-
4], a
vaila
ble
at h
ttp:
//w
ww
.cdc
.gov
/mm
wr/
pdf/
rr/r
r560
4.pd
f) h
ave
2 do
ses
of v
aric
ella
vac
cine
. Fo
r chi
ldre
n ag
ed 7
thro
ugh
12 y
ears
, the
reco
mm
ende
d m
inim
um in
terv
al b
etw
een
dose
s is
3 m
onth
s (if
the
seco
nd d
ose
was
adm
inis
tere
d at
leas
t 4 w
eeks
aft
er th
e fir
st d
ose,
it c
an b
e ac
cept
ed a
s va
lid);
for p
erso
ns a
ged
13 y
ears
and
old
er, t
he m
inim
um in
terv
al b
etw
een
dose
s is
4 w
eeks
.11
. H
epat
itis
A (H
epA
) vac
cine
. (M
inim
um a
ge: 1
2 m
onth
s)Ro
utin
e va
ccin
atio
n:•
Initi
ate
the
2-do
se H
epA
vac
cine
serie
s at 1
2 th
roug
h 23
mon
ths;
sepa
rate
the
2 do
ses b
y 6
to 1
8 m
onth
s. •
Child
ren
who
hav
e re
ceiv
ed 1
dos
e of
Hep
A v
acci
ne b
efor
e ag
e 24
mon
ths s
houl
d re
ceiv
e a
seco
nd d
ose
6 to
18
mon
ths a
fter
the
first
dos
e.•
For a
ny p
erso
n ag
ed 2
yea
rs a
nd o
lder
who
has
not
alre
ady
rece
ived
the
Hep
A v
acci
ne se
ries,
2 do
ses o
f H
epA
vac
cine
sepa
rate
d by
6 to
18
mon
ths m
ay b
e ad
min
iste
red
if im
mun
ity a
gain
st h
epat
itis A
viru
s in
fect
ion
is d
esire
d.
Catc
h-up
vac
cina
tion
:•
The
min
imum
inte
rval
bet
wee
n th
e tw
o do
ses
is 6
mon
ths.
Spec
ial p
opul
atio
ns:
•Ad
min
iste
r 2 d
oses
of H
epA
vac
cine
at l
east
6 m
onth
s apa
rt to
pre
viou
sly
unva
ccin
ated
per
sons
who
liv
e in
are
as w
here
vac
cina
tion
prog
ram
s tar
get o
lder
chi
ldre
n, o
r who
are
at i
ncre
ased
risk
for i
nfec
tion.
Th
is in
clud
es p
erso
ns tr
avel
ing
to o
r wor
king
in c
ount
ries t
hat h
ave
high
or i
nter
med
iate
end
emic
ity o
f in
fect
ion;
men
hav
ing
sex
with
men
; use
rs o
f inj
ectio
n an
d no
n-in
ject
ion
illic
it dr
ugs;
pers
ons w
ho w
ork
with
HAV
-infe
cted
prim
ates
or w
ith H
AV in
a re
sear
ch la
bora
tory
; per
sons
with
clo
ttin
g-fa
ctor
dis
orde
rs;
pers
ons w
ith c
hron
ic li
ver d
isea
se; a
nd p
erso
ns w
ho a
ntic
ipat
e cl
ose,
per
sona
l con
tact
(e.g
., hou
seho
ld
or re
gula
r bab
ysitt
ing)
with
an
inte
rnat
iona
l ado
ptee
dur
ing
the
first
60
days
aft
er a
rriv
al in
the
Uni
ted
Stat
es fr
om a
cou
ntry
with
hig
h or
inte
rmed
iate
end
emic
ity. T
he fi
rst d
ose
shou
ld b
e ad
min
iste
red
as
soon
as t
he a
dopt
ion
is p
lann
ed, i
deal
ly 2
or m
ore
wee
ks b
efor
e th
e ar
rival
of t
he a
dopt
ee.
12.
Hum
an p
apill
omav
irus
(HPV
) vac
cine
s. (
Min
imum
age
: 9
year
s fo
r HPV
2 [C
erva
rix]
and
HPV
4 [G
ardi
sil])
Ro
utin
e va
ccin
atio
n:•
Adm
inist
er a
3-d
ose
serie
s of H
PV v
acci
ne o
n a
sche
dule
of 0
, 1-2
, and
6 m
onth
s to
all a
dole
scen
ts a
ged
11
thro
ugh
12 y
ears
. Eith
er H
PV4
or H
PV2
may
be
used
for f
emal
es, a
nd o
nly
HPV
4 m
ay b
e us
ed fo
r mal
es.
•Th
e va
ccin
e se
ries
may
be
star
ted
at a
ge 9
yea
rs.
•Ad
min
iste
r the
sec
ond
dose
1 to
2 m
onth
s af
ter t
he fi
rst d
ose
(min
imum
inte
rval
of 4
wee
ks),
adm
inis
ter t
he th
ird d
ose
24 w
eeks
aft
er th
e fir
st d
ose
and
16 w
eeks
aft
er th
e se
cond
dos
e (m
inim
um
inte
rval
of 1
2 w
eeks
).Ca
tch-
up v
acci
nati
on:
•Ad
min
iste
r the
vac
cine
ser
ies
to fe
mal
es (e
ither
HPV
2 or
HPV
4) a
nd m
ales
(HPV
4) a
t age
13
thro
ugh
18
year
s if
not p
revi
ousl
y va
ccin
ated
.•
Use
reco
mm
ende
d ro
utin
e do
sing
inte
rval
s (s
ee a
bove
) for
vac
cine
ser
ies
catc
h-up
.
13.
Men
ingo
cocc
al c
onju
gate
vac
cine
s. (M
inim
um a
ge: 6
wee
ks fo
r Hib
-Men
CY [M
enH
ibri
x], 9
mon
ths
for
Men
ACW
Y-D
[Men
actr
a], 2
mon
ths
for M
enA
CWY-
CRM
[Men
veo]
)Ro
utin
e va
ccin
atio
n:•
Adm
inis
ter a
sin
gle
dose
of M
enac
tra
or M
enve
o va
ccin
e at
age
11
thro
ugh
12 y
ears
, with
a b
oost
er
dose
at a
ge 1
6 ye
ars.
•Ad
oles
cent
s ag
ed 1
1 th
roug
h 18
yea
rs w
ith h
uman
imm
unod
efici
ency
viru
s (H
IV) i
nfec
tion
shou
ld
rece
ive
a 2-
dose
prim
ary
serie
s of
Men
actr
a or
Men
veo
with
at l
east
8 w
eeks
bet
wee
n do
ses.
•Fo
r chi
ldre
n ag
ed 2
mon
ths
thro
ugh
18 y
ears
with
hig
h-ris
k co
nditi
ons,
see
belo
w.
Catc
h-up
vac
cina
tion
:•
Adm
inis
ter M
enac
tra
or M
enve
o va
ccin
e at
age
13
thro
ugh
18 y
ears
if n
ot p
revi
ousl
y va
ccin
ated
.•
If th
e fir
st d
ose
is a
dmin
iste
red
at a
ge 1
3 th
roug
h 15
yea
rs, a
boo
ster
dos
e sh
ould
be
adm
inis
tere
d at
ag
e 16
thro
ugh
18 y
ears
with
a m
inim
um in
terv
al o
f at l
east
8 w
eeks
bet
wee
n do
ses.
•If
the
first
dos
e is
adm
inis
tere
d at
age
16
year
s or
old
er, a
boo
ster
dos
e is
not
nee
ded.
•Fo
r oth
er c
atch
-up
guid
ance
, see
Fig
ure
2.Va
ccin
atio
n of
per
sons
wit
h hi
gh-r
isk
cond
itio
ns a
nd o
ther
per
sons
at i
ncre
ased
risk
of d
isea
se:
•Ch
ildre
n w
ith a
nato
mic
or f
unct
iona
l asp
leni
a (in
clud
ing
sick
le c
ell d
isea
se):
1. F
or c
hild
ren
youn
ger t
han
19 m
onth
s of a
ge, a
dmin
iste
r a 4
-dos
e in
fant
serie
s of M
enH
ibrix
or M
enve
o at
2, 4
, 6, a
nd 1
2 th
roug
h 15
mon
ths
of a
ge.
2. F
or c
hild
ren
aged
19
thro
ugh
23 m
onth
s w
ho h
ave
not c
ompl
eted
a s
erie
s of
Men
Hib
rix o
r Men
veo,
ad
min
iste
r 2 p
rimar
y do
ses
of M
enve
o at
leas
t 3 m
onth
s ap
art.
3. F
or c
hild
ren
aged
24
mon
ths
and
olde
r w
ho h
ave
not
rece
ived
a c
ompl
ete
serie
s of
Men
Hib
rix o
r M
enve
o or
Men
actr
a, a
dmin
iste
r 2 p
rimar
y do
ses o
f eith
er M
enac
tra
or M
enve
o at
leas
t 2 m
onth
s apa
rt.
If M
enac
tra
is a
dmin
iste
red
to a
chi
ld w
ith a
sple
nia
(incl
udin
g si
ckle
cel
l dis
ease
), do
not
adm
inis
ter
Men
actr
a un
til 2
yea
rs o
f age
and
at l
east
4 w
eeks
aft
er th
e co
mpl
etio
n of
all
PCV1
3 do
ses.
•Ch
ildre
n w
ith p
ersi
sten
t com
plem
ent c
ompo
nent
defi
cien
cy:
1. F
or c
hild
ren
youn
ger t
han
19 m
onth
s of
age
, adm
inis
ter a
4-d
ose
infa
nt s
erie
s of
eith
er M
enH
ibrix
or
Men
veo
at 2
, 4, 6
, and
12
thro
ugh
15 m
onth
s of
age
. 2.
For
chi
ldre
n 7
thro
ugh
23 m
onth
s w
ho h
ave
not i
nitia
ted
vacc
inat
ion,
two
optio
ns e
xist
dep
endi
ng
on a
ge a
nd v
acci
ne b
rand
: a.
For
chi
ldre
n w
ho in
itiat
e va
ccin
atio
n w
ith M
enve
o at
7 m
onth
s thr
ough
23
mon
ths o
f age
, a 2
-dos
e se
ries
shou
ld b
e ad
min
iste
red
with
the
seco
nd d
ose
afte
r 12
mon
ths
of a
ge a
nd a
t lea
st 3
mon
ths
afte
r the
firs
t dos
e.
b. F
or ch
ildre
n w
ho in
itiat
e va
ccin
atio
n w
ith M
enac
tra
at 9
mon
ths t
hrou
gh 2
3 m
onth
s of a
ge, a
2-d
ose
serie
s of
Men
actr
a sh
ould
be
adm
inis
tere
d at
leas
t 3 m
onth
s ap
art.
c. F
or c
hild
ren
aged
24
mon
ths
and
olde
r w
ho h
ave
not
rece
ived
a c
ompl
ete
serie
s of
Men
Hib
rix,
Men
veo,
or M
enac
tra,
adm
inis
ter 2
prim
ary
dose
s of e
ither
Men
actr
a or
Men
veo
at le
ast 2
mon
ths
apar
t. •
For c
hild
ren
who
trav
el to
or r
esid
e in
cou
ntrie
s in
whi
ch m
enin
goco
ccal
dis
ease
is h
yper
ende
mic
or
epi
dem
ic, i
nclu
ding
cou
ntrie
s in
the
Afr
ican
men
ingi
tis b
elt o
r the
Haj
j, ad
min
iste
r an
age-
ap
prop
riate
form
ulat
ion
and
serie
s of
Men
actr
a or
Men
veo
for p
rote
ctio
n ag
ains
t ser
ogro
ups
A a
nd
W m
enin
goco
ccal
dis
ease
. Prio
r rec
eipt
of M
enH
ibrix
is n
ot s
uffici
ent f
or c
hild
ren
trav
elin
g to
the
men
ingi
tis b
elt o
r the
Haj
j bec
ause
it d
oes
not c
onta
in s
erog
roup
s A
or W
. •
For c
hild
ren
at ri
sk d
urin
g a
com
mun
ity o
utbr
eak
attr
ibut
able
to a
vac
cine
ser
ogro
up, a
dmin
iste
r or
com
plet
e an
age
- and
form
ulat
ion-
appr
opria
te s
erie
s of
Men
Hib
rix, M
enac
tra,
or M
enve
o.•
For b
oost
er d
oses
am
ong
pers
ons
with
hig
h-ris
k co
nditi
ons,
refe
r to
MM
WR
2013
62(
RR02
); 1-
22,
avai
labl
e at
htt
p://
ww
w.c
dc.g
ov/m
mw
r/pr
evie
w/m
mw
rhtm
l/rr6
202a
1.ht
m.
Catc
h-up
reco
mm
enda
tion
s fo
r per
sons
wit
h hi
gh-r
isk
cond
itio
ns:
1. I
f Men
Hib
rix is
adm
inis
tere
d to
ach
ieve
pro
tect
ion
agai
nst m
enin
goco
ccal
dis
ease
, a c
ompl
ete
age-
appr
opria
te s
erie
s of
Men
Hib
rix s
houl
d be
adm
inis
tere
d.2.
If t
he fi
rst d
ose
of M
enH
ibrix
is g
iven
at o
r aft
er 1
2 m
onth
s of a
ge, a
tota
l of 2
dos
es sh
ould
be
give
n at
le
ast 8
wee
ks a
part
to e
nsur
e pr
otec
tion
agai
nst s
erog
roup
s C
and
Y m
enin
goco
ccal
dis
ease
.3.
For
chi
ldre
n w
ho in
itiat
e va
ccin
atio
n w
ith M
enve
o at
7 m
onth
s th
roug
h 9
mon
ths
of a
ge, a
2-d
ose
serie
s sh
ould
be
adm
inis
tere
d w
ith t
he s
econ
d do
se a
fter
12
mon
ths
of a
ge a
nd a
t le
ast
3 m
onth
s af
ter t
he fi
rst d
ose.
4. F
or o
ther
cat
ch-u
p re
com
men
datio
ns fo
r the
se p
erso
ns, r
efer
to M
MW
R 20
13 6
2(RR
02);
1-22
, ava
ilabl
e at
htt
p://
ww
w.c
dc.g
ov/m
mw
r/pr
evie
w/m
mw
rhtm
l/rr6
202a
1.ht
m.
For c
ompl
ete
info
rmat
ion
on u
se o
f men
ingo
cocc
al v
acci
nes,
incl
udin
g gu
idan
ce re
late
d to
va
ccin
atio
n of
per
sons
at i
ncre
ased
risk
of i
nfec
tion
, see
MM
WR
Mar
ch 2
2, 2
013
/ 62(
RR02
);1-2
2,
avai
labl
e at
htt
p://
ww
w.c
dc.g
ov/m
mw
r/pd
f/rr
/rr6
202.
pdf.
For f
urth
er g
uida
nce
on th
e us
e of
the
vacc
ines
men
tione
d be
low
, see
: htt
p://
ww
w.c
dc.g
ov/v
acci
nes/
hcp/
acip
-rec
s/in
dex.
htm
l.
153
Index
AAcellular pertussis vaccine schedule,
147–148Acetaminophen, 144Acid phosphate, 68Activity, Apgar score, 3Adolase, 68Adolescent(s)
amikacin dosing for, 126–127cholesterol levels in, 76–77creatinine levels in, 73dietary intake recommendations for,
117–118fibrinolytic system in, 93fluoride supplementation for, 119fosphenytoin dosing for, 134–135galactose levels in, 74gentamicin dosing for, 128–129glucose levels in, 74HDL/LDL in, 77hematology values of, 85immunization schedules for, 146–151lactate levels in, 76levetiracetam dosing for, 136–137lymphocyte subset counts in, 94–96phenobarbital dosing for, 138–139phosphorus levels in, 77prealbumin levels in, 78protein levels in, 78serum 17 hydroxyprogesterone in,
100tobramycin dosing for, 130–131topiramate dosing for, 140–141transferrin levels in, 79triglycerides levels in, 79troponin-1 levels in, 80uric acid levels in, 80
valproic acid dosing for, 142–143vancomycin dosing for, 132–133vitamin A levels in, 80vitamin E levels in, 81
Adult(s)acid phosphate levels in, 68adolase levels in, 68alanine aminotransferase levels in, 68alkaline phosphatase levels in, 69ammonia levels in, 69amylase levels in, 69bilirubin levels in, 71calcium levels in, 72carbon monoxide levels in, 72cerebrospinal fluid values in, 65–66chloride levels in, 72cholesterol levels in, 76–77coagulation tests, 92cobalamin levels in, 81creatinine levels in, 73erythrocyte sedimentation rate in, 73Fe-binding capacity in, 79ferritin levels in, 73fibrinolytic system in, 93folate levels in, 73–74formulas for, 112–115γ-Glutamyl transferase in, 74gas levels in, 71HDL/LDL in, 77hematology values of, 85hemoglobin levels in, 75inhibition of coagulation in, 92iron levels in, 75phenylalanine levels in, 77potassium levels in, 78serum 17 hydroxyprogesterone in,
100
154 Index
Adult(s), continuedthyroid function tests, 98transferrin levels in, 79urea nitrogen levels in, 80
Ageblood pressure and, 58–63head circumference for, 11, 18length/weight percentiles and, 10, 17stature for, 12, 19weight for, 14, 21
Alanine aminotransferase, 68Alkaline phosphatase, 69Amikacin, 126–127Amino acid-based formulas
for adults, 115for infants, 111for older children, 115for young children, 113
Ammonia, 69Amylase, 69Anion gap, 105Antibiotic dosing
amikacin, 126–127gentamicin, 128–129tobramycin, 130–131vancomycin, 132–133
Antinuclear antibodies, 69Antiseizure dosing
fosphenytoin, 134–135levetiracetam, 136–137phenobarbital, 138–139topiramate, 140–141valproic acid and derivatives, 142–143
Antistreptolysin, 70Apgar score, 3Appearance, Apgar score, 3Arterial lactate, 76Aspartate aminotransferase, 70
BBehavior, PEWS for, 7Bicarbonate(s), 70, 116Bilirubin, 70–71Biotin, 117Blood. See also Coagulation
gas, 71glucose, 65lymphocyte subset counts in, 94–96serum, 73
Blood pressureby age and height, 58–63nomograms
children younger than one year, 57
first day of life, 54first few weeks of life, 56first twelve hours or life, 53
Blood urea nitrogen, 83BMI. See Body mass indexBody mass index, 13, 16, 20, 23Body surface area, 9Boy(s)
blood pressure levels in, 58–60growth charts for
birth to 24 months, 17–18BMI, 20, 23Down syndrome-associated, 41–42Fenton preterm, 29head circumference, 18IHDP, 34–37length-for-age, 17neonatal curve, 26–27stature for age, 19two to twenty years, 19–23weight-for-age, 17, 19, 22weight-for-stature, 21–22
Breathing. See Respiration
155Index
CC-reactive protein, 72Calcium
in adult formulas, 114–115in infant formulas, 110–111recommended intakes, 117units of, 72
Calculated serum osmolality, 105Calories
in adult formulas, 114–115in children’s formulas, 113–114common supplements, 108soy formulas, 107standard formulas, 107
Capillary blood, 76Carbohydrates
in adult formulas, 114–115in children’s formulas, 113–114in infant formulas, 110–111in oral rehydration fluids, 116recommended intake, 117units of, 107
Carbon dioxide, 72Carbon monoxide, 72Cardiovascular system, 7Casein formulas, 110–111Catheterization measurements, 121–124Celsius conversion, 2Cerebrospinal fluids, 65–66Children. See also Boys; Girls
acid phosphate levels in, 68adolase levels in, 68alanine aminotransferase levels in, 68alkaline phosphatase levels in, 69amikacin dosing for, 126–127ammonia levels in, 69amylase levels in, 69antistreptolysin levels in, 70aspartate aminotransferase levels
in, 70bicarbonate levels in, 70
calcium levels in, 72cerebrospinal fluid values in, 65–66chloride levels in, 72cholesterol levels in, 76–77coagulation tests, 92cobalamin levels in, 81creatinine levels in, 73dietary intake recommendations for,
117–118erythrocyte sedimentation rate in, 73ferritin levels in, 73fibrinolytic system in, 93fluoride supplementation for, 119folate levels in, 73–74formulas for, 112–115fosphenytoin dosing for, 134–135galactose levels in, 74γ-Glutamyl transferase in, 74gas levels in, 71gentamicin dosing for, 128–129glucose levels in, 74growth hormone values in, 99HDL/LDL in, 77hematology values of, 84immunization schedules for, 146–151inhibition of coagulation in, 92iron levels in, 75lactate dehydrogenase levels in, 76lactate levels in, 76lead levels in, 76levetiracetam dosing for, 136–137lipase levels in, 76lymphocyte subset counts in, 94–96phenobarbital dosing for, 138–139phosphorus levels in, 77potassium levels in, 78prealbumin levels in, 78protein levels in, 78serum 17 hydroxyprogesterone in,
100sodium levels in, 79
156 Index
Children, continuedwith special needs, growth charts,
38–43thyroid function tests, 98tobramycin dosing for, 130–131topiramate dosing for, 140–141transferrin levels in, 79triglycerides levels in, 79troponin-1 levels in, 80urea nitrogen levels in, 80uric acid levels in, 80valproic acid dosing for, 142–143vancomycin dosing for, 132–133vitamin A levels in, 80vitamin E levels in, 81
Chloride, 72, 118Chlorine, 82Cholesterol, 76–77Choline, 117Chromium, 117Coagulation tests, 88–92Consolability pain scale, 6Conversions, 1–2Copper, 118Cortisol levels, 99Cow’s milk-based formulas
for adults, 114–115for infants, 110for young children, 112–113
Creatine kinase, 73Creatinine, 73Cry pain scale, 6
DDiabetes mellitus, 75Diphtheria vaccine schedule, 147–148Down syndrome, 39–40
EEar above eye measurements, 49Endocrine laboratory values, 99–100Erythrocyte sedimentation rate, 73
Exchange transfusion nomogram, 101Extremities, growth measures, 44–48
FFace pain scale, 6Fahrenheit conversion, 2Fats
in adult formulas, 114–115calories in, 107in infant formulas, 110–111intake recommendations, 117
Ferritin, 73Fiber, 117Fibrinolytic system, 93FLACC pain scale, 6Fluoride
intake recommendations, 118sources, 119supplementation schedule, 119
Folate, 73–74, 117Forearm length, 45Formulas
for adults, 114–115amino acid-based, 111, 113caloric counts, 107casein, 110–111cow’s milk-based, 110, 112, 114for infants, 108–111for older children, 114–115pork-based, 113semi-elemental, 110soy-based, 110, 113specialized, 111whey, 111for young children, 112–113
Fosphenytoin, 134–135
GGalactose, 74γ-Glutamyl transferase, 74Gentamicin, 128–129Gestational age, 4
157Index
Girl(s)blood pressure levels in, 61–63growth charts for
birth to 24 months, 10–11BMI, 13, 16Down syndrome-associated, 39–40 Fenton preterm, 28head circumference, 11IHDP, 30–33length-for-age, 10neonatal curve, 24–25two to twenty years, 12–16weight-for-age, 10, 12, 15weight-for-stature, 14–15
Glucosein children, 74infusion rate, 105in neonates, 82in oral rehydration fluids, 116reference range values of, 65in rehydration fluids, 116
Grimace, Apgar score, 3Growth charts
body surface area, 9boys’
birth to 24 months, 17–18BMI, 20, 23IHDP, 34–37length-for-age, 17neonatal curve, 26–27two to twenty years, 19–23weight-for-age, 17, 19, 22weight-for-stature, 21–22
for children with special needs, 38Fenton preterm, 28–29girls’
birth to 24 months, 10–11BMI, 13, 16IHDP, 30–33length-for-age, 10neonatal curve, 24–25two to twenty years, 12–13, 16
weight-for-age, 10, 12, 15weight-for-stature, 14–15
primary teeth eruption, 51Growth hormone values, 99Growth measures, 44–49
HHaemophilus influenzae type b vaccine
schedule, 147–148Haptoglobin, 74HDL. See High-density lipoproteinHead circumference
birth to 24 months, 11, 18LBW preterms, 31neonatal growth, 25, 27VLBW preterms, 33, 35, 37
Heart rate, 8Height
blood pressure levels and, 58–63conversion formulas, 1Down syndrome charts, 39–41
Hematocrit, 82Hematology values, 84Hemoglobin, 75, 82Hepatitis A vaccine schedule, 147–148Hepatitis B vaccine schedule, 147–148High-density lipoprotein, 77Human papillomavirus vaccine schedule,
147–148Hyperbilirubinemia management
exchange transfusion nomogram, 101phototherapy nomogram, 101risk nomogram, 101
IImmunization schedules, 146–151Inactivated poliovirus vaccine schedule,
147–148Infant(s)
amikacin dosing for, 126–127aspartate aminotransferase levels
in, 70
158 Index
Infant(s), continuedbicarbonate levels in, 70bilirubin levels in, 70–71calcium levels in, 72cerebrospinal fluid values in, 65–66chloride levels in, 72coagulation tests, 86–87creatinine levels in, 73dietary intake recommendations for,
117–118Fe-binding capacity in, 79ferritin levels in, 73fluoride supplementation for, 119fosphenytoin dosing for, 134–135γ-Glutamyl transferase in, 74gentamicin dosing for, 128–129hematology values of, 84hemoglobin levels in, 75immunization schedules for, 146–151inhibition of coagulation in, 88–90iron levels in, 75lactate dehydrogenase levels in, 76lactate levels in, 76levetiracetam dosing for, 136–137lipase levels in, 76lymphocyte subset counts in, 94–96phenobarbital dosing for, 138–139phosphorus levels in, 77potassium levels in, 78prealbumin levels in, 78protein levels in, 78serum 17 hydroxyprogesterone in, 100sodium levels in, 79thyroid function tests, 98tobramycin dosing for, 130–131topiramate dosing for, 140–141transferrin levels in, 79triglycerides levels in, 79troponin-1 levels in, 80urea nitrogen levels in, 80uric acid levels in, 80valproic acid dosing for, 142–143
vancomycin dosing for, 132–133vitamin A levels in, 80vitamin E levels in, 81
Influenza vaccine schedule, 147Iodine, 118Iron
in adult formulas, 114–115in children’s formulas, 113–114in infant formulas, 110–111units of, 75
Iron-binding capacity, 79
KKetones, 75
LLactate, 66, 82Lactate dehydrogenase, 76Lactation, 117–118LDL. See Low-density lipoproteinLead, 76Legs pain scale, 6Legs, lower length chart, 48Length
for age percentiles, 10, 17forearm, 45LBW preterms, 30long bone, 46–47lower leg, 48neonatal growth curve, 27upper arm, 44VLBW preterms, 32, 34, 36
Levetiracetam, 136–137Lipase, 76Lipids, 76Long bone length, 46–47Low birth weight preterms
boys’ growth charts, 34–38girls’ growth charts, 30–33
Low-density lipoprotein, 77LBW. See Low birth weight pretermsLymphocytes, 65, 94–96
159Index
MMagnesium
intake recommendations, 118in neonates, 82units for, 77
Manganese, 118Meningococcal vaccine schedule, 148Methemoglobin, 77Milligram conversions, 1Milliosmois conversions, 1MMR (measles, mumps, rubella) vaccine
schedule, 147–148Monocytes, 65
NNew Ballard score, 4–5Newborn(s)
acid phosphate levels in, 68adolase levels in, 68alanine aminotransferase levels in, 68alkaline phosphatase levels in, 69amikacin dosing for, 126–127ammonia levels in, 69amylase levels in, 69antistreptolysin levels in, 70aspartate aminotransferase levels
in, 70bicarbonate levels in, 70bilirubin levels in, 70, 71blood pressure nomograms, 53–56calcium levels in, 72chloride levels in, 72cobalamin levels in, 81core blood chemistry, 82–83creatine kinase levels in, 73creatinine levels in, 73ferritin levels in, 73folate levels in, 73–74fosphenytoin dosing for, 134–135galactose levels in, 74γ-Glutamyl transferase in, 74gas levels in, 71
gentamicin dosing for, 128–129glucose levels in, 74growth curve in, 24–27growth hormone values in, 99haptoglobin in, 74hematology values of, 84hemoglobin levels in, 75immunization schedules for, 146–151iron levels in, 75lactate dehydrogenase levels in, 76lactate levels in, 76levetiracetam dosing for, 136–137lipase levels in, 76lymphocyte subset counts in, 94–96phenobarbital dosing for, 138–139phosphorus levels in, 77phenylalanine levels in, 77potassium levels in, 78prealbumin levels in, 78protein levels in, 78tobramycin dosing for, 130–131topiramate dosing for, 140–141transferrin levels in, 79triglycerides levels in, 79troponin-1 levels in, 80two to four blood chemistry, 82–83urea nitrogen levels in, 80uric acid levels in, 80vancomycin dosing for, 132–133
Niacin. See Vitamin B3
Nonsmokers, 72Nutrition
adult formulas, 114common supplements, 108infant formulas, 108–111intake recommendations, 117–118older children formulas, 114preterm formulas, 108soy formulas, 107standard formula, 107toddler formulas, 113young children formulas, 113
160 Index
OOpening pressure, 65–66Oral rehydration fluids, 116Osmolality
in adult formulas, 114–115in children’s formulas, 113–114in infant formulas, 110–111in oral rehydration fluids, 116units of, 77
PPain scales, 6Pantothenic acid, 117Pediatric early warning score (PEWS),
7–8PEWS. See Pediatric early warning score
(PEWS)pH, 82Phenobarbital, 138–139Phosphorus
in adult formulas, 114–115in children’s formulas, 113–114in infant formulas, 110–111recommended intake of, 118units of, 77
Phototherapy nomogram, 102Phenylalanine, 77Physical maturity, 5Pneumococcal conjugate vaccine sched-
ule, 147–148Pneumococcal polysaccharide vaccine
schedule, 147–148Polymorphonuclear cells, 65Porcelain, 77Pork-based formulas, 113Potassium
in adult formulas, 114–115blood levels, 82in children’s formulas, 113–114intake recommendations, 118in oral rehydration fluids, 116
in rehydration fluids, 116units in children, 78
Prealbumin, 78Pregnancy, 117–118Preterm infant(s)
bilirubin levels in, 70blood pressure and, 54–56calcium levels in, 72cerebrospinal fluid values in, 65–66Fenton growth charts, 28–29glucose levels in, 74IHDP growth charts
boys, 34–37girls, 30–33
phenylalanine levels in, 77potassium levels in, 78protein levels in, 78thyroid function tests, 97urea nitrogen levels in, 80vitamin A levels in, 80vitamin E levels in, 81
Proteinsin adult formulas, 114–115in children’s formulas, 113–114clinical chemistry, 78in infant formulas, 110–111intake recommendations, 117reference range values of, 65in supplements, 107
Pulse, Apgar score, 3
RRabies guidelines, 145Red blood cells, 65, 74Respiration
Apgar score, 3fluctuation with, 66PEWS for, 7–8
Riboflavin. See Vitamin B2
Risk nomogram, 101Rotavirus vaccine schedule, 147, 148
161Index
SScales for pain, 6Scores
Apgar, 3New Ballard, 4–5PEWS, 7–8
Selenium, 118Semi-elemental formulas
for adults, 115for older children, 115for young children, 113
Serum 17 hydroxyprogesterone, 100Smokers, 72Sodium
in adult formulas, 114–115in children’s formulas, 113–114in infant formulas, 110–111intake recommendations, 118in oral rehydration fluids, 116in rehydration fluids, 116units in children, 79
Soy-based formulasfor adults, 115for infants, 110for older children, 115for young children, 113
Specialized formulas, 111Stature for age, 12, 19
TTeeth, eruption chart, 51Temperature conversions, 2Tetanus vaccine schedule, 147–148Thiamin. See Vitamin B1
Thyroid function tests, 97–98Tobramycin, 130–131Topiramate, 140–141Topomax. See TopiramateTransferrin, 79Triglycerides, 79Troponin-1, 80
UUmbilical cords
bilirubin levels in, 70blood gas in, 71creatinine in, 73γ-Glutamyl transferase in, 74protein levels in, 78
Umbilical vein/artery, 121–124Upper arm length, 44Urea nitrogen, 80Uric acid, 80
VValproic acid, 142–143Vancomycin, 132–133Varicella vaccine schedule, 147–148Venous lactate, 76Very low birth weight preterms
boys’ growth charts, 34–38girls’ growth charts, 30–33thyroid function tests, 97–98
Vitamin A, 80, 117Vitamin B1, 80, 117Vitamin B12, 81, 117Vitamin B2, 80, 117Vitamin B3, 117Vitamin C, 81, 117Vitamin D3, 81, 117Vitamin E, 81, 117Vitamin K, 117VLBW. See Very low birth weight preterms
WWeight
for age percentiles, 10, 12, 15, 17, 19, 22
birthblood pressure and, 54catheterization measurement and,
121–124conversion formulas, 1Down syndrome charts, 39–41
162 Index
Weight, continuedLBW preterm, 30for stature percentiles, 14–15, 21–22VLBW preterms, 32, 34, 36
Weight-for-length percentilesLBW preterms, 31VLBW preterms, 33, 35, 37
Weight-for-stature percentiles, 14–15, 21–22
Whey formulas, 111White blood cells, 65, 94
ZZinc, 81, 118
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ssary
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tions
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tsse
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Thes
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Am
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edia
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Brig
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ture
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eA
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cont
inue
sto
emph
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eth
egr
eat
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rtan
ceof
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com
preh
ensi
vehe
alth
supe
rvis
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and
the
need
toav
oid
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men
tatio
nofca
re.
1.If
ach
ildco
mes
unde
rca
refo
rth
efir
sttim
eat
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poin
ton
the
sche
dule
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ifan
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ms
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not
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mpl
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gest
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lesh
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ible
time.
2.A
pren
atal
visi
tis
reco
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ende
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rent
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high
risk,
for
first
-tim
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rent
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rth
ose
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est
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nfer
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sit
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ldin
clud
ean
ticip
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ertin
ent
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ical
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scus
sion
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nefit
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etho
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per
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56].
3.E
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stfe
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cour
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4.E
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ude
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enco
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34].
5.B
lood
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and
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ren
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spec
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risk
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atvi
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reag
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onte
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All
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ear
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Pos
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and
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ram
s.Ped
iatrics.
2007
;120
:898
–921
.
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AP
Cou
ncil
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hild
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abili
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elop
men
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right
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ome
Initi
ativ
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Spe
cial
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dsP
roje
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ory
Com
mitt
ee.I
dent
ifyin
gin
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san
dyo
ung
child
ren
with
deve
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enta
ldis
orde
rsin
the
med
ical
hom
e:an
algo
rithm
for
deve
lopm
enta
lsur
veill
ance
and
scre
enin
g.Ped
iatrics.
2006
;118
:405
–420
[UR
L:ht
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ions
.org
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5].
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upta
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,Hym
anS
L,Jo
hnso
nC
P,et
al.I
dent
ifyin
gch
ildre
nw
ithau
tism
early
?Ped
iatrics.
2007
;119
:152
–153
[UR
L:ht
tp:/
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iatr
ics.
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atio
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rg/c
gi/c
onte
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ull/1
19/1
/152
].10
.A
tea
chvi
sit,
age-
appr
opria
teph
ysic
alex
amin
atio
nis
esse
ntia
l,w
ithin
fant
tota
llyun
clot
hed,
olde
rch
ildun
dres
sed
and
suit-
ably
drap
ed.
11.
Thes
em
aybe
mod
ified
,dep
endi
ngon
entr
ypo
int
into
sche
dule
and
indi
vidu
alne
ed.
12.
New
born
met
abol
ican
dhe
mog
lobi
nopa
thy
scre
enin
gsh
ould
bedo
neac
cord
ing
tost
ate
law
.Res
ults
shou
ldbe
revi
ewed
atvi
sits
and
appr
opria
tere
test
ing
orre
ferr
aldo
neas
need
ed.
13.
Sch
edul
espe
rth
eC
omm
ittee
onIn
fect
ious
Dis
ease
s,pu
blis
hed
annu
ally
inth
eJa
nuar
yis
sue
ofPed
iatrics.
Eve
ryvi
sit
shou
ldbe
anop
port
unity
toup
date
and
com
plet
ea
child
’sim
mun
izat
ions
.14
.S
eeA
APPed
iatric
NutritionHan
dboo
k,5t
hE
ditio
n(2
003)
for
adi
scus
sion
ofun
iver
sala
ndse
lect
ive
scre
enin
gop
tions
.See
also
Rec
omm
enda
tions
topr
even
tan
dco
ntro
liro
nde
ficie
ncy
inth
eU
nite
dS
tate
s.MMWR.1
998;
47(R
R-3
):1–3
6.15
.Fo
rch
ildre
nat
risk
ofle
adex
posu
re,c
onsu
ltth
eA
AP
stat
emen
t“L
ead
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osur
ein
Chi
ldre
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reve
ntio
n,D
etec
tion,
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agem
ent”
(200
5)[U
RL:
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1036
].A
dditi
onal
ly,s
cree
n-in
gsh
ould
bedo
nein
acco
rdan
cew
ithst
ate
law
whe
reap
plic
able
.16
.P
erfo
rmris
kas
sess
men
tsor
scre
ens
asap
prop
riate
,bas
edon
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ersa
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ortof
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onre
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isk
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Cop
yrig
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2008
byth
eA
mer
ican
Aca
dem
yof
Ped
iatr
ics.
No
part
ofth
isst
atem
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may
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inan
yfo
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byan
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with
out
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rmis
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from
the
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anA
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my
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sex
cept
for
one
copy
for
pers
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use.