BACKGROUND AND OBJECTIVES: The effects of endocrinological treatment on cardiovascular risk profile in transgender adolescents are unknown. In this retrospective cohort study, we aim to investigate... Show moreBACKGROUND AND OBJECTIVES: The effects of endocrinological treatment on cardiovascular risk profile in transgender adolescents are unknown. In this retrospective cohort study, we aim to investigate these effects and assess obesity and dyslipidemia prevalence in transgender adolescents at 22 years compared with peers.METHODS: Changes in BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and lipid values during treatment, along with the prevalence of obesity and dyslipidemia at 22 years, were recorded in 71 transwomen and 121 transmen who started gonadotropin-releasing hormone agonists in their adolescence (15 years), with a subsequent addition of sex hormones (17 years).RESULTS: In transwomen, changes in BMI (13.0; 95% confidence interval [CI] 1.6 to 4.4), SBP (22 mmHg; 95% CI 27 to 3), DBP (110 mmHg; 95% CI 7 to 14), glucose (0.0 mmol/L; 95% CI 20.2 to 0.2), HOMA-IR (10.6; 95% CI 20.6 to 1.9), and lipid values were similar or more favorable compared with peers. The same was true for transmen regarding changes in BMI (12.3; 95% CI 1.7 to 2.9), SBP (17 mmHg; 95% CI 3 to 10), DBP (17 mmHg; 95% CI 5 to 10), glucose (10.1 mmol/L; 95% CI 20.1 to 0.3), HOMA-IR (20.2; 95% CI 20.8 to 0.3), and lipid values. At age 22, obesity prevalence was 9.9% in transwomen, 6.6% in transmen, 2.2% in ciswomen, and 3.0% in cismen.CONCLUSIONS: Generally, endocrinological treatment in transgender adolescents is safe regarding cardiovascular risk. Because obesity is more prevalent in transgender adolescents compared with peers, body weight management should be important during the medical trajectory. Show less
To describe the developmental trajectories of mobility performance and daily activities in children and young adults with cerebral palsy (CP). To explore the influence of gross motor function and... Show moreTo describe the developmental trajectories of mobility performance and daily activities in children and young adults with cerebral palsy (CP). To explore the influence of gross motor function and intellectual disability on these trajectories.|Four hundred and twenty-four Dutch participants with CP (aged 1-20 years at study onset) were followed yearly over a period of 2 to 4 years. Developmental trajectories (from ages 1-16 years) were described for mobility performance and performance of daily activities, assessed by using the Vineland Adaptive Behavior Scale for gross motor function (classified by the Gross Motor Function Classification System) and intellectual disability (by IQ or school type). A subanalysis was done for performance of daily activities in a subgroup of participants without intellectual disability (aged 1-24 years).|The developmental trajectories of mobility performance differed according to levels of gross motor function but not levels of intellectual disability. Intellectual disability affected the performance of daily activities, with lower overall trajectory levels for participants with intellectual disabilities. For participants without intellectual disability, high-level developmental trajectories were found, with values similar to those of typically developing children despite differences in gross motor function level.|Mobility performance is determined mainly by levels of gross motor function. For performance of daily activities, intellectual disability was a more important determinant. Participants without intellectual disability showed developmental trajectories approaching values for typically developing participants. These estimated trajectories can guide rehabilitation interventions and future expectations for children and young adults with CP. Show less
OBJECTIVE: Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need... Show moreOBJECTIVE: Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need respiratory support in the NICU, but international resuscitation guidelines do not stipulate use of this therapy during stabilization at birth. We aimed to investigate the effect of humidified and heated gas on admission temperature in preterm infants who require respiratory support at birth. METHODS: Two cohorts of very preterm infants born at <= 32 weeks' gestational age in the Leiden University Medical Center were compared prospectively before (the "cold" cohort) and after (the "heated" cohort) introduction of the use of heated and humidified gas during respiratory support at birth (continuous positive airway pressure or intubation). The primary outcome was the infant's rectal temperature at admission in the NICU. RESULTS: There was a difference in the mean (SD) rectal temperature between the cold and heated cohorts (35.9 [0.6] vs 36.4 [0.6], respectively; P < .0001). Normothermia (36.5 degrees C-37.5 degrees C) occurred less often in the cold cohort than in the heated cohort (12% vs 43%; P < .0001). There was no difference in occurrence of mild hypothermia (36.0 degrees C-36.4 degrees C) between groups (33% vs 35%; not significant). Moderate hypothermia (<36.0 degrees C) occurred more often in the cold cohort (53% vs 19%; P < .001). CONCLUSIONS: The use of heated and humidified air during respiratory support in very preterm infants just after birth reduced the postnatal decrease in temperature. Heating and humidifying the gas during stabilization merits additional investigation. Pediatrics 2010; 125: e1427-e1432 Show less
