In a small regional survey of direct spectrophotometric methods and a larger Australian and New Zealand survey of paediatric bilirubin analyses, the overall performance of both groups was unsatisfactory with an unacceptable high interlaboratory variation. This inter-laboratory variation was reduced significantly by the use of a spectrophotometric method with a common standard of methyl orange.

The Australian and New Zealand survey also examined the "state of the art" for the measurement of conjugated bilirubin and showed that laboratories could not adequately measure conjugated bilirubin.

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