{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:54:40Z","timestamp":1789786480955,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002759","name":"CARES Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002759","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K23HD084735"],"award-info":[{"award-number":["K23HD084735"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R03HD101718"],"award-info":[{"award-number":["R03HD101718"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005317","name":"Abell Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Infants and toddlers with classical congenital adrenal hyperplasia (CAH) are at high risk for morbidity\/mortality arising from life\u2010threatening adrenal crisis. Management of acute illnesses in CAH requires an understanding of factors leading to emergency department (ED) visits and hospitalizations in the first few years of life. We, therefore, examined adrenal crisis at prehospital and ED stages of illness in young children with CAH as they related to medical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Design<\/jats:title><jats:p>Retrospective cohort study of 39 children with CAH due to 21\u2010hydroxylase deficiency (0\u20134 years of age) and 27 age\u2010matched controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>ED visit, acute illness symptoms (fever, vomiting, diarrhoea) and other characteristics (hospitalizations, administration of stress\u2010dose hydrocortisone, electrolyte abnormalities).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CAH infants and toddlers had significantly higher rates of ED visits (0.50 [0.25\u20130.88] per person\u2010year) than controls (0 [0\u20130] per person\u2010year; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Moreover, CAH children under 6 months old had significantly higher rates of ED visits compared with older ages. Only 50% (51\/102) of illness\u2010related ED visits in CAH children were preceded by the administration of either oral (46\/51) or intramuscular (11\/51) stress dosing by parents. A total of 10.8% of ED visits resulted in hospital admission. Controlling for age and 17\u2010hydroxyprogesterone at diagnosis, electrolyte abnormalities and administration of parenteral hydrocortisone in the ED significantly predicted hospital admission. Receiving a hydrocortisone injection before the ED was a significant predictor of having electrolyte abnormalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Infants and toddlers with classical CAH are at high risk for acute illness and hospitalizations and often do not receive adequate stress dosing before the ED.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14876","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T02:59:17Z","timestamp":1672714757000},"page":"536-542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Electrolyte abnormalities and stress dosing predict illness\u2010related hospitalizations among infants and toddlers with congenital adrenal hyperplasia"],"prefix":"10.1111","volume":"98","author":[{"given":"Teresa","family":"Tseng","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Seagroves","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veeraya K.","family":"Tanawattanacharoen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Liang","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M.","family":"Koppin","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Keenan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elana","family":"Davidowitz","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Chand","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell E.","family":"Geffner","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"},{"name":"The Saban Research Institute  Los Angeles California USA"},{"name":"Division of Emergency Medicine Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd P.","family":"Chang","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of University of Southern California  Los Angeles California USA"},{"name":"The Saban Research Institute  Los Angeles California USA"},{"name":"Division of Emergency Medicine Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6266-3569","authenticated-orcid":false,"given":"Mimi S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism Children's Hospital Los Angeles  Los Angeles California USA"},{"name":"The Saban Research Institute  Los Angeles California USA"},{"name":"Division of Emergency Medicine Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"issue":"6","key":"e_1_2_9_2_1","first-page":"866","article-title":"Worldwide experience in newborn screening for classical congenital adrenal hyperplasia due to 21\u2010hydroxylase deficiency","volume":"81","author":"Pang SY","year":"1988","journal-title":"Pediatrics"},{"key":"e_1_2_9_3_1","volume-title":"Pediatric Practice: Endocrinology","author":"Kim 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Second\u2010tier Congenital Adrenal Hyperplasia Proficiency Testing Program (CAHPT)(CDC). February 2017.\u00a0Accessed March 25 2022.\u00a0https:\/\/www.cdc.gov\/labstandards\/pdf\/nsqap\/nsqap_CAHFeb2017.pdf"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1909786"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab600"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1687-9856-2010-275213"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jspn.12190"},{"key":"e_1_2_9_28_1","unstructured":"CARES Foundation. Advocacy: Be Prepared for An Emergency! (caresfoundation.org). Accessed March 25 2022.https:\/\/caresfoundation.org\/treatment-illness-emergency\/"},{"key":"e_1_2_9_29_1","unstructured":"Basic Scope of Practice of Emergency Medical Technician. California Code of Regulations Section 100063 (emsa.ca.gov). 2017. 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