Comparison of various methods for amniotic fluid DeltaOD450 bilirubin measurement.

BACKGROUND: The purpose of this study was to investigate the degree of DeltaOD450 method variability and its effect on DeltaOD450 measurements between selected clinical laboratories in the U.S. METHOD: Four amniotic fluid specimens were sent to 7 clinical laboratories in the U.S. for DeltaOD450 analysis. In addition, scanning spectrophotometric data from 152 amniotic fluid samples were used to compare DeltaOD450 values calculated using both log and linear OD scales. RESULTS: We found that no 2 laboratories used exactly the same method and no laboratory used precisely the same method as originally described by Liley. Despite the varied methods, the DeltaOD450 measurements were remarkably similar. The exception was 1 sample that was subjected to chloroform extraction. The DeltaOD450 measurement on this sample was 82% lower than the mean. On average, DeltaOD450 results determined from a linear OD scale were 37% lower than those determined from a log scale. CONCLUSION: Although there is no standard method for performing the DeltaOD450, inter-laboratory variation of DeltaOD450 results is remarkably small. As our and other previous studies have reported, these data suggest that both chloroform extraction and use of a linear scale have the potential to result in lower DeltaOD450 results.

Trends in Atypical Antipsychotics Prescribed to Children Six Years of Age or Less on Medicaid in Kentucky.

OBJECTIVE: Studies have shown an increase in the use of antipsychotics to preschoolers for disruptive behavior and aggression. This study investigated the use of atypical antipsychotics in children ≤6 years of age in Kentucky who were on Medicaid. METHODS: Kentucky Medicaid prescription claims data between 2001 and 2010 were examined for all children ≤6 years of age who had received an atypical antipsychotic. Drug type, diagnosis codes, and geographic trends were analyzed using descriptive statistics. RESULTS: A total of 70,777 prescriptions were written to 6915 distinct children ≤6 years of age. The use of atypical antipsychotics in this age group increased over the years 2001-2010 with a peak ∼ 1.0% in 2004, and averaged 0.75% in 2010. Older male children were more likely to receive atypical antipsychotics, and risperidone accounted for two thirds of the prescriptions written. Mood disorders, primarily bipolar disorder, accounted for almost 75% of the diagnoses provided. Only 32% of the prescriptions were written by child psychiatrists. Geographic analysis showed significantly higher use in the Western part of the state (more than three times the state mean in some counties). CONCLUSIONS: The use of atypical antipsychotics in children ≤6 years of age has declined from its peak, but remains substantial. The prescription rates for atypical antipsychotics by providers other than child psychiatrists, and the marked geographic variation in use across the state of Kentucky suggest that improved systems of mental healthcare for this population are needed.