Advancing excellence in laboratory medicine for better healthcare worldwide

Paediatric Reference Range Initiatives

To coordinate activities worldwide directed towards the establishment of reference ranges for laboratory test results in paediatric patients of all age groups


HAPPI Kids – Harmonising Age Pathology Parameters in Kids 

The HAPPI Kids (Harmonising Age Pathology Parameters in Kids) study at the Royal Children’s Hospital Melbourne (RCH), Victoria, Australia commenced in 2015. HAPPI Kids has collected approximately 5000 paediatric blood samples from premature infants, term infants and children until 18 years old with the overall aim to verify existing age-appropriate reference intervals at multiple laboratory sites within Victoria for general biochemistry, haematology, immunology analytes using multiple analyser platforms. The HAPPI Kids reference intervals will evaluated in conjunction with the published AACB Harmonised paediatric references and be available for implementation by public hospital and private laboratories and paediatric centres in Victoria, Australia by 2018.

Please contact the Principal Investigator, Professor Paul Monagle ( or AACB member and Principal Scientist RCH, Dr Susan Matthews ( for further project information.


Pathology Harmony Group

"The phase II work of the Pathology Harmony Group produced reference ranges for three age groups (neonates, infants, 1-16 yrs) for a variety of common analytes which were accepted into practice by April 2011.


KiGGS - The German Health Interview and Examination Survey for Children and Adolescents.

Between May 2003 and May 2006, the nationwide German Health Interview and Examination Survey for Children and Adolescents ("KiGGS") studied the health of children and adolescents between the ages of 0 and 17 inGermany. One of the study investigated the Population-Based Distribution of Selected Laboratory Parameters.

This contribution presents the percentile distributions of key laboratory parameters observed in the KiGGS. The KiGGS data are based on a sample size of more than 14,000 blood and serum samples, which is large enough to map the age- and gender-specific histories of the individual parameters. The reference figures provided in this publication can be used in the future as background information in clinical and population-based studies. (German version only)


Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER)

The Canadian Society of Clinical Chemists recently published a report from it Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) initiative outlining  a new comprehensive database of 40 Biochemical Markers in a Healthy and Multiethnic Population of Children. This is a nation-wide initiative to improve the diagnosis and care of children at SickKids and health-care institutions acrossCanada!


American Association for Clinical Chemistry Pediatric Reference Range Initiative

AACC is working to improve the pediatric reference intervals (PRI) used by clinicians and other health care providers to appropriately interpret test results and make critical decisions involving children's health. This initiative, spearheaded by the Association's Pediatric Reference Range Committee (PRRC) and Pediatric and Maternal-Fetal (PMF) Division, is committed to:

  • Educating key stakeholders about the need for new pediatric reference intervals;
  • Fostering greater collaboration and sharing of data among interested parties; and
  • Promoting new research to create the data needed for developing new pediatric reference ranges.

To kickoff this effort, the PRRC is conducting a research study in 2012, using blood spots from the NIH National Children's Study, to generate new reference ranges for certain amino acids and steroids.


Children's Health Improvement through Laboratory Diagnostics (CHILDx)

CHILDx was formed in 1999, sponsored by ARUP Laboratories and the University of Utah Department of Pathology, and includes a National Advisory Committee. CHILDx focuses on the unique challenges of pediatric laboratory medicine. Clinical laboratory testing is generally done by measurement of substances in serum or urine. One aspect of this study is focusing on determining pediatric reference intervals for a number of clinical laboratory assays by collecting both blood and urine specimens from normal subjects.


NORICHILD: Scandinavian Initiative for the Establishment of Pediatric Reference Intervals


B. Lindblad, T Alström, A. Bo Hansen et al. Recommendation for collection of venous blood from children, with special reference to production reference values Scandinavian Journal of Clinical & Laboratory Investigation1990,50, No. 1 , Pages 99-104

Colantonio DA, Kyriakopoulou L, Chan MK, Daly CH, Brinc D, Venner AA, Pasic MD, Armbruster D, Adeli K. Closing the Gaps in Pediatric Laboratory Reference Intervals: A CALIPER Database of 40 Biochemical Markers in a Healthy and Multiethnic Population of Children Clin Chem. 2012 May;58(5):854-68

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