title: Improving surveillance for hyperammonemia in the newborn.
abstract: OBJECTIVE
  Prompt ascertainment is crucial for the management of hyperammonemic infants. Because these patients are rare and recognition of hyperammonemia is often delayed, we designed and implemented an electronic medical record (EMR)-based tool to assist physicians in the detection of hyperammonemia.
  
  
  METHODS
  We retrospectively evaluated the hospitalizations of prior hyperammonemic infants to identify codable elements that could trigger an EMR-based warning. An alert was designed and implemented and its utilization was prospectively analyzed.
  
  
  RESULTS
  Blood gas studies were obtained universally and early in the retrospectively evaluated infants (x¯=26h before ammonia level). Prompting physicians to evaluate ammonia after ordering blood gas studies would have accelerated the initial ammonia order in 89% of retrospective cases. The alert has activated 184 times over the first six months of operation leading to 63 laboratory evaluations and detection of one hyperammonemic infant.
  
  
  CONCLUSIONS
  Implementation of an EMR-based warning system can improve surveillance for hyperammonemia in a susceptible population.
authors.affiliation: Section of Biochemical Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Vergano
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Crossette
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Cusick
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Desai
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Deardorff
authors.forename: Neal
authors.initials: N
authors.lastname: Sondheimer
mesh_terms: D000641:Ammonia / Q000378:metabolism*; D057286:Electronic Health Records; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014508:Urea / Q000378:metabolism*
chemical_list: D000641:Ammonia; D014508:Urea
keywords: CMP; EMR; Electronic medical record; IEM; Infant; Screening; UCD; Urea cycle defect; comprehensive metabolic panel; electronic medical record; inborn error of metabolism; urea cycle disorder